§5ibra*tj of §v\\pt$$ 

DOTTED STATES OF AMERICA. 



PBACTICAL TREATISE. 



***a 



A. 

PRACTICAL TREATISE 

ON THE 

DISEASES AND ABUSES 

OF THE 

SEXUAL SYSTEM, 

WITH ILLUSTRATIVE PLATES. 

BY JOSEPH RALPH, M. D., 

Graduate of the University of Edinburgh ^Member of the Royal 
College of Surgeons, London, ;-and Author of * 

lhe Family Physician," fyc, fyc 



"^^^a^I~^^^ arena 



EIGHTEENTH EDITION, 
REVISED AND CORRECT 



E. D. LONG No. 121 NASSAU STREET. 




1857. 






1 



Entered according to an Act of Congress, in the year one thousand eight 
hundred and fifty-seven, by Joseph £. Ralph, M. 1>. 










CONTENTS 



Chap. I. — On Gonorrhoea— Its Nature, Symptoms, Progress, and 
Consequences. 

Chap. II. — On the Remedies and Treatment of Gonorrhoea. 

Chap. III. — On the Accidental Symptoms of Gonorrhoea, viz : Pain 
in Urinating, Phymosis, Paraphymosis, Chordee, Bubo, 
Swelled Testicle. Their Treatment. 

Chap. IV. — On Gonorrhoea in the Eyes, and Gonorrheal Rheuma- 
tism. Their Treatment. 

Chap. V. — On Gonorrhoea in Females — Its Treatment. 

Chap. VI. — On Gleet. Its Nature and Treatment. 

Chap. VII. — On certain diseases resembling Gonorrhoea in some 
respects, and which are frequently mistaken for it ; but 
which, nevertheless, are totally distinct and different dis- 



Chap. VIII. — On Leucorrhoea, " Female Weakness," or " Whites.', 
Its Treatment. 

Chap. IX. — On Stricture of the Urinary Passage. Its Nature, 
Symptoms, Consequences, Remedies, and Treatment. 

Chap. X. — On Masturbation, called also Onanism, Self-pollution , 
&c. 



Chap. XI. — On the Consequences of Masturbation. 

Chap. XII. — On Masturbation. Its Treatment. 

Chap. XIII. — On Syphilis or Venereal Disease. Its Distinguish- 
ing Marks, Nature, Symptoms, Progress, and Consequences. 

Chap. XIV. — On the Remedies and Treatment of Venereal disease. 

Chap. XV. — On Venereal Bubo, Phymosis, Paraphymosis, Venere- 
al Warts. Their Treatment. 

Chap. XVI.— On Venereal Sore Throat. Its Treatment. 

Ghap. XVII . — On Venereal Blotches and Eruptions on the Skin, 
Their Treatment. 

Chap. XVIII. — On Venereal in the Bones, Nose, Palate, fyc. Its 
Treatment. 

Chap. XIX. — On Venereal Taint in the Constitution. The effects 
of Venereal Diseases upon Posterity, The eradication of 
the Poison from the System. The Treatment of Syphilisin 
Infants. 

Chap. XX. — On certain Complaints which resembles Venereal 
Disease, and sometimes arise from Sexual Intercourse, but 
which, nevertheless, are not Venereal, nor can be treated as 
such without the greatest disadvantage. Persons affected 
with these are often cruelly imposed upon by advertising 
people. 






SHOULD BE CAREFULLY READ BY ALL MARRIED, OR 
CONTEMPLATING MARRIAGE. 



Having been frequently asked by patients if certain results could not be produced 
by either medical or mechanical means, or a combination of both : — after a series of 
experiments and the severest tests in a number of cases, the author is happy in stating 
emphatically that those results can be brought about by a mild and pleasant treat- 
ment, permanent in it3 effects, and attended certainly, with the most happy conse- 
quences to those who may be unfortunately united for life to one of a temperament 
the opposite of their own, and render married life one of happiness instead of misery* 
a blessing in lieu of a curse. 

Unfortunately for society, many are under the impression that all women are 
warm and passionate — that their bosoms swell more with soft desire than purer emo- 
tions. Fie upon you ! — harbor no such ungenerous thought ! 

Why do not men study female character, and appreciate her deservingly 1 She 
is g«ntle and confiding — often yielding without desire, because husbands wish and 
claim their privileges. 

Is there a husband who possesses one spark of affection for a devoted wife, who 
does not really wish that she may share all the joys of wedlock in the highest degree 1 
1 think not ; and yet how many who, not from want of will or ordinary capacities* 
but from want of self-controlling power, cannot bring about the extatic pleasures 1 

In prescribing treatment for diseases or derangements of the'sexual organs, there 
are many points of singular and peculiar interest, which should be kept in view. In 
many cases there may be no disease, deficiency or malformation ; yet, the precipitan- 
cy or quickness of the male in the sexual embrace is often a source of mortification 
and disgust to the female. In married life there is indeed much suffering and vexa- 
tion. A most tantalizing source of annoyance is when there is so great a difference 
in natures, passions, &c , that there is no real enjoyment in the copulative act, the 
male being too quick in almost all cases. It is to this important point that I would 
call your special attention. 



There are certain means by which the activity of certain organs, and their auxili- 
aries, can be equalized, and only during the act can sufficient of the active principle 
be secreted to consummate the act, consequently the pleasures must be more endur- 
ing, and much greater. This treatment is offered only to those married, or contem- 
plating marriage, and is calculated to bring opposite sexes (ro matter how great the 
difference m natures,) to a mutual reciprocation of thoughts, feelings, desires, &c, 
and without which, there is little, if an}% real enjoyment in married life. 

During this treatment there is little medicine used, few if any restrictions required* 
the general health improved, the tone and vigor of the organs fully restored, no 
matter how weak or sensitive they may have become from excesses, or a total absti- 
nence from sexual commerce ; will also enable either and both parties to prolong the 
act and increase the extatic pleasures. 

Puritans may scoff, the bigotted sneer, and fools laugh, but the Author begs to 
state emphatically, tbat in the event of a reflecting commuuity's allowing him to 
practically demonstrate his views, the result must be that every wife will have the 
best husband, and every husband the best wife in the world, because they will be mu- 
tually satisfied and pleased. 

The moral influence which must result is quite clear to every intelligent and re- 
flecting mind. No satisfied and happy husband or wife will ever give the substance 
for the shadow ; — they will never seek and risk finding pleasures abroad which they 
are certain of having at home. # 

All deficiencies, malformations, weaknesses, &c, treated carefully and successful- 
ly. All letters to receive attention, should state case fully, and enclose the usual 
consulting fee. 



Address, W. H. MORRIS, M. D., Box 869, P. O., N. V. City. 



CHRONIC AND CONSTITUTIONAL DISEASES, 



In order t>? correct an erroneous notion that many entertain since he relinquished a 
general or family practice, Dr. Ralph would here observe that he has for some years 
past confined himself to an Office-practice, for the treatment of all Chronic Affections, 
as well as those referred to in his " Practical Treatise ;" and that, associated with 
him in this practice is Dr. Wm. H. Morris, late of Nashville, Tenn., who for seve- 
ral years has had an extensive and successful practice there in Chronic and Female 
Complaints, fyc. By thus restricting the practice to this important and too generally 
ill-treated class of diseases, we are enabled to give them that attention they demand, and 
for the want of which their treatment (in the hands of Physicians generally) so often 
proves unsatisfactory and useless, if not even worse. 

Drs. Ralph and Morris, therefore beg to call the attention of those laboring 
under Chronic complaints to the following remarks : 

These affections require a judicious and careful treatment, varied according to the 
stage of the disease, as well as the age, sex, habits, &c, of the patient ; unless this 
be observed strictly, little if any good can result from any treatment, even though 
followed for half a lifetime. "We wish it understood that we do not use specifics, but 
treat all patients in a scientific and thorough manner ; and where directions are 
strictly followed, will warrant safe and permanent cures. 

Dyspepsia and Liver Disease, and all the consequences attending derangement 
of the Organs of Digestion, Irregular Bowels, Flatulency, Nervousness and Hypo- 
chondria, fyc. 

Piles — a disease closely connected with the above, is cured without an operation 
in a few days. Those who apply early will find relief in a few hours. 

Rheumatism, Scofula and Skin Diseases, Fistula, Dropsy — will find a thor- 
ough treatment and pleasant cure. 

Diseases of the Bladder and Kidnies, Gravel, Enlargement of Prostate 
Gland, and all Urinary complaints; Stricture of the urethra; also, all derange- 
ments and weakness of the sexual organs in either sex, admit of positive and radical 
cure without the use of mercurials, or any offensive medicines or tiresome restrictions. 

Asthma — and all chronic Affections of the Lungs ; in the worst cases of Asthma, 
relief may be obtained in a few days, and a permanent cure can be effected in a short 
time. 

Female Complaints — than which no class of diseases require a more careful arid 
judicious treatment to produce a permanent good, are treated in a safe and skillful 



manner, pointed out by a long course of successful practice. Ladies who desire a 
safe and easy time should make application a few weeks before the time of accouch- 
ment. It should, however, be distinctly understood that the subject of prevention or 
abortion is not here included — time and trouble will be saved by neither calling nor 
writing on this subject. Safe, pleasant and positive treatment for the removal or 
Worms, Eruptions of the Skin, and all Chronic complaints peculiar to infants and 
children. 

Diarrhcea, Dysentery, Bowel Complaints, &c, speedily and effectually 
cured. In time of Cholera a remedy is kept constantly prepared, a single dose 
of which will arrest the premonitory symptoms, and a very few doses will cure it 
when fully set in. This medicine is pleasant to the taste, perfectly safe, (containing 
neither opium, lead or any dangerous ingredient), and has been fully tested in several 
Epidemics. We should, at such time, always be pleased to give a dose to any one 
having the premonitory symptoms, who will call at our office. 

JOSEPH RALPH, M. D., WM. H. MORRIS, M. D., 

(Author of the "Practical Treatise" fyc.) {Formerly of Nashville, Tenn.) 

Offices, ^MM teew -St reet, near Webster, N. Y. City. 

At Home till One and alter Six O'clock, (Sunday excepted.) 
Patients visited at their Hotel if necessary. 

Treatment by Letter. — Patients at a distance, by stating their symptoms, &c. 
will meet with prompt attention. 

All Letters must enclose a fee, and may be diricted to Box 869, P. O., New York 
City. 

Medtcines — are securely enveloped and safely sent to all parts of the United 
States, Canadas, South America, West Indies, &c. 

P. S — For some important remarks and suggestions to the married, or those con- 
templating marriage, enclose two U. S. postage stamps, addressed, " Box 869 P O." 



The following remarks upon a most common but least understood disease, viz. : 
Stricture, its Symptoms, Effects, fyc, will, it is believed, prove interesting to 
many : — 

1st. — That Stricture is a very common malady, and frequently exists in those 
who are not the least aware of it. 

2d. — That a very erroneous notion prevails with regard to Stricture. 

3d — That although a Stricture may long remain so dormant, as not to be sus- 
pected, it is always tending to other forms of sexual disorder. 

4th. — That there are three circumstances in particular, by which a Stricture may 
always be known. 

5th — That the cure of Stricture, especially in its early stage, is certain, free from 
pain or inconvenience, and generally accomplished in a very little time. 

1 — With regard to the frequency of Stricture, this will not surprise if it is con- 
sidered that this complaint proceeds from a badly treated Gonorrhoea. If for instance 
this disease has been suffered to continue on from month to month, it slides into a 
Gleet. Now, there is no pain or inconvenience in Gleet, and on this account it is often 
suffered to remain for any length of time. But it should be known that Gleet is 



generally connected with Chronic Inflammation, which naturally terminates in thick- 
ening, and this thickening in one part or other of the urinary passage is Stricture ; 
and further with regard to its obscurity, this thickening may exist without a Gleet, 
and in that case there is nothing whatever to call the attention to it, so that the 
gufferer must remain in perfect darkness as to the real nature of his malady. 

2 — Another thing that leads the attention off from this disorder, is the erroneous 
notion that stricture cannot exist so long as no impediment to the flow of urine is 
observed. But this is quite wrong. A stricture may exist for years without producing 
any striking change in this respect. Indeed this effect upon the urine, is observed 
only in advanced and older cases, while the visible effect of early stricture is not on 
the part itself, but on the mind, causing lowness of spirits and want of resolution. 

3 — But, although a mild or early stricture is seemingly inactive, and of no account, 
it is far from being really so. It is scarcely possible for those not acquainted with 
minute anatomy, to imagine the delicate and peculiar structure of the part which is 
the seat of this disease, and how little is sufficient to derange it. Now, this morbid 
condition of the passage whether connected with stricture, or induced by other and 
pernicious causes, is ever tending to destroy those delicate organs, laying the foun- 
dation of some of the most distressing maladies of human nature. It is in this way 
that melancholy and even suicidal feelings, dyspepsia, local debility, too great quick- 
ness* in the sexual act, impotence, an irritable bladder, and other like diseases, 
proceed from a mild and unsuspected stricture. 

4 — Nothing therefore, can be more desirable than to have some plain and ready 
means of detecting stricture in its mild and early stage ; and, fortunately , there are 
three particular circumstances, which for many years, the author has found to suit 
this purpose. They are the following. The first relates to — 

The Manner of Urinating. — It has been said already that the stream need not 
be much diminished or impeded, and that is true ; but observe what happens after 
this is finished, and the clothes are readjusted, and if it should be found that a drop 
or two will afterwards steal away, so as to wet a little, this, trifling as it may seem 
will afford a ground of strong suspicion. The next regards. 

The Time a Former Disease may have Remained Uncured. — It is not so 
much how long ago it may have occurred, as how long the gleety stage may have 
continued. Neither is it possible in every case to state the length of time a gleet may 
run without producing stricture, for one is naturally more disposed to stricture than 
another. Asa general rule, however, if a Gonorrhoea has been suffered to continue 

* This quicknkss or precipitate discharge in the sexual act. is s» cau e of no little annoyance to 
the married on hoth s de — in the o e causing shame aid mortification as well as deprivation of due 
pleasure— on the other, a dissati fied feeln g, often resulting in di gust of the ac altogether, and of- 
tener tha» is supposed, being th<? first and real— though misunderst. od bv either party, cause of infi- 
delity and all its miseries. Now. this fault may be the result of former disease, or have had no such 
cau^e ; in either case however it 1- gratifying to be able to assure all so afflicted that it is REMEDIA- 
BLE ; and that «ith very little medicine, and nothing troublesome, inconvenient or disagreeable. 
The necessary instructors and remedies (occupying but little space) are sent by mail to any pa-t of 
the country o' elsewhere, with perlect safet\ and certainty. Addressing on this sul ject, be particu- 
lar to state whether there has been previous disease, abuse, or excess— also age, temperament, &c, 



for a period of from si* to eight weeks, this would stregthen any ■»«»»! *■>» 
fumstance. Also the praetice of Masturbation, or self-abuse >n youth, m a common 
cause. The third is 

The Effect a Stftcturk has upos the Miw.-This, in the early stage, is to 
depress theTpirit" and to lessen mental energy. It is also one of its most mvanable 
tffe NoWhat this is seen in the same degree in every individual but .t ,s so com- 

t Id, writer scarcely sees a case of stricture in which ,he PaUeutdoesnoUom. 
plain that he is less active, and less capable of business than formerly Much ^gh 
be advanced to show the natural connection of the m.nd and genera .veogans but 
for this the reader is referred to the Author's " Practical Treatise," whde the fact 
itself is proved by the return of mental energy as the cure proceeds. 

S^-With respect to the cure of strieture-this may now be accomplished in very 

Tear's To those who cannot leave their homes, his own peculiar means o ur , with 
Z tmrZus adapted to each particular case, can he ^^^^ "f t0 
any part of the United States, Canadas, South America, or West Indies, &c. 

A LL Lkttkhs must enclose a fee, and are addressed to JOSEPH RALPH, M.D. 
Box 869 P. 0., N. Y. City. (The name may be omitted if preferred.) 



Offices, 6*3 Houston -Street, near Wooster, N. Y. City. 



ygy /dM^AtJ^*-^ 



C« 



At Home till One and after Sit O'clock, (Sunday excepted.) 
Patients Tisited at their Hotel if necessary. 



PRACTICAL TREATISE. 



&c. &c. 



PART THE FIRST. 



CHAPTER I. 



On Gonorrhcea. — Its Nature, Symptoms, Progress and 
Consequences. 

The first thing to know on this subject, is, that Gonor- 
rhoea and Venereal Disease are two distinct and very 
different disorders. A person having Gonorrhoea, for 
instance, cannot give another the Venereal disease ; nor 
can one having Venereal Disease give to another the 
Gonorrhcea. Neither, again, can a Gonorrhoea change 
into the Venereal, nor Venereal into the Gonorrhoea 
Both diseases, however, may perchance exist in one and 
the same person, and then, both may be communicated 
at the same time, or one alone, just as it may happen. 
Hut the thing to be remembered is, that they are two di i :~ 



find diseases, and this is the more important, because, as 
I shall presently have to show, they require very differ- 
ent remedies and modes of cure. 

I will now proceed to give a description of the first of 
these complaints — the Gonorrhoea — the one upon which 
we are now engaged, and this shall be done in words as 
few and as plain as possible, so that, by comparing it 
with the description of the Venereal, which shall imme 
diately follow, any one may see the difference between 
these two diseases in a moment. 

Gonorrhoea, then, is an infectious disease ; it is seated 
in the urinary passage, from the orifice of which there 
issues a discharge of matter, attended, more or less, with 
pain and heat in making water. There is no outward 
sore or ulcer in Gonorrhoea; neither indeed is there any 
within the passage. If it were possible to take an in- 
side view of the urinary passage, nothing would be seen 
there but redness and a little swelling, and the discharge, 
whether much or little, would be seen issuing from the 
red and swollen state of the membrane which lines it just 
as matter is sometimes seen issuing from an inflamed eye 

Venereal Disease, on the contrary, is not seated in the 
urinary passage, but externally, on some part or other of 
the penis or genital organs, and consists in one or more 
little ulcers or sores, which do not heal like others, but 
continue unhealed, and, at length assume a peculiar cha- 
racter. 



Gonorrhoea, then, consists in a discharge from the urin- 
ary passage, attended, more or less, with pain and heat in 
making water, without ulceration or sores ; whereas Ve- 
nereal Disease consists in external ulceration or sores, 
without discharge from the urinary passage, and without 
pain or heat in making water. No one, it is presumed, 
after this can possibly mistake these two diseases, and it 
will therefore now be proper to describe particularly how 
a Gonorrhoea commences and proceeds. 

But before entering upon a particular history of this 
disease, it is desirable to say a word or two respecting the 
time when a Gonorrhoea first appears after an exposure to 
it; for many persons wrong themselves with dread and 
apprehension long after there is the least occasion for it ; 
To the question then so often put, — When may 1 consider 
I am safe? I reply, after the seventh day, if none of the 
symptoms presently to be mentioned should appear, you 
may consider you have escaped, — that you are safe. It 
is true there is some difference in the time of its appearing 
in different individuals. Some have said, for instance, 
they have known it to appear in twenty-four hours, and 
others that it has ! ^een delayed for ten or even fourteen 
days. I very r^uch doubt, however, whether it ever ap- 
pears at this early period. Instances of this kind which 
have occurred to me, have always proved to be cases of 
Stricture, not of Gonorrhoea, the discharge being the im- 
mediate consequences of an irritation of the pre-existing 
disease ; while those delayed for fourteen days are very 



rare. I never met with one myself, though such are 
occasionally related to me. By far the most common 
period is the third day. The seventh is the longest I have 
ever met with, and it is on the ground of this experience 
I venture now to say that, whoever has passed the seventh 
day without any of the symptoms presently to be men- 
tioned, may consider he is safe — that he has escaped — 
however suspicious the party may have been. This much 
then as to the time when a Gonorrhoea begins, and now 
as to its manner of beginning. 

A person having been exposed to this infectious malady, 
at some period within seven days, if he should have taken 
the disorder (which we will suppose to be the first attack) 
will feel a little pain and heat in making water. This 
leads him to make an examination, when he will find the 
orifice of the urinary passage looks a little redder than 
usual, its lips rather pouting or swollen, and on squeezing 
it, an uncommon dampness or thin mucus will be seen. 
In the course of a few hours, or by the next day, the 
pain and heat in making water will have increased, the 
discharge also increased and of a purulent or white 
creamy appearance. For some days these symptoms go 
on increasing in severity, the matter becoming of a yel- 
lowish color. Sometimes the pain and heat in making 
water will be exceedingly great, amounting to a sensa- 
tion of absolute scalding: at this time the discharge 
generally turns to a greenish color, and instead of being 
about as thick as cream, is thin and watery. Under these 



circumstances there is also a painful sensation along the 
whole length of the urinary passage, and the penis swells 
and is subject to attacks of frequent and very painful 
erection. 

A Gonorrhoea always begins with pain and inflamma- 
tion, more or less, which, after a little while, abates or 
subsides entirely. In speaking of a Gonorrhoea, therefore, 
we call the beginning of it, its Inflammatory Stage. But 
the degree of pain and inflammation at the beginning of 
Gonorrhoea, differs exceedingly in different persons; some 
will have so little as scarcely to complain at all, while 
others suffer most severely ; as a general rule, however, 
the oftener it is had, the less inflammatory is its attack, 
so that, those who have had Gonorrhoea several times may 
experience actually no pain at all, the only notice of its 
existence being the appearance of the matter on the 
clothes; but, in every case, after a time, this inflammation 
subsides, whether anything is done for it or not. Persons 
(coming from some of the advertising quacks) will often 
say, "but the stuff they gave me removed the burning 
pain," when, in fact it has nothing at all to do with it ; 
for unless the heating things they generally give increase 
the burning pain, it subsides itself, spontaneously This 
then is the first or Inflammatory Stage. 

The seat of Gonorrhoea, at its commencement, is just 
within the orifice of the urinary passage, this necessarily 
being the part that first comes in contact with the infec- 



tious matter — that first receives the inoculation. But the 
disease is not long confined to this spot, its tendency is to 
progress further and further along the urinary canal until 
it reaches to very near its other end, and there it settles 
down. How long a time it may occupy in its progress 
through the urinary canal, is uncertain, and differs in 
different individuals and under different circumstances of 
constitution, mode of life, &c. The painful inflammato- 
ry symptoms however, seem principally to attend the in- 
vasion of the disease, and, most of all, its effect upon the 
first portion of the passage ; when these are subsided, at 
any rate, we may consider it has advanced to its ordinary 
distance. 

After a long time then, or, if there has been much pam, 
after this has subsided, another stage of the disease com- 
mences. This stage consists simply of an infectious dis- 
charge issuing from the orifice of the penis, with little or 
no pain. This discharge is more or less in quantity in 
different persons, and is much increased by whatever may 
excite, or by irregularities of any kind. This, especially 
when the discharge is slight and quite unattended with 
pain, is what is properly called " Gleet," (see Chapter 
vi.), and, when once suffered to commence, there is no 
exactly telling how long it may continue, or how it is to 
terminate ; but let it ever be remembered, that, as long 
as this discharge continues, the disease may be communi- 
cated by infection. This, then, is the Second or Chronic 
Stage of Gonorrhoea. 



But thus far I have spoken of a Gonorrhoea in its sim- 
ple form, and have mentioned those symptoms only which 
are essential to it, and which are never absent from it; 
there are however other symptoms which are only some- 
times present, which may or may not exist, but which, 
when they do occur (and some of them generally do) form 
the severest part of the complaint and call for immediate 
and peculiar remedies. In fact, it is for the want of 
knowing something of the nature of these accidental symp- 
toms, that Gonorrhoea assumes its most distressing cha- 
racter, and leads to the worst consequences. Those cir- 
cumstances which may or may not occur in Gonorrhoea, 
and are called accidental symptoms, are the following : 
a swelling of the prepuce or foreskin ; — swelling of t&e 
glands in the groin ; — very painful erections of the penis ; 
— and swelling of the testicles. The nature of these 
therefore is now to be explained, but the particular mode 
of treating them will be given in another Chapter, (in). 
First, then of 

Swelling of the Prepuce or Foreskin. 

This is the effect of inflammation, which a full and 
irritable disposition or irregularity of habits gives rise to. 
The structure of the skin which covers the head of the 
penis (the prepuce) is very loose and cellular, so that when 
the inflammation happens to be high, this structure fills 
with the thin and colorless part of the blood which causes 
it to swell. 



Sometimes the skin is swollen amazingly, and looks of 
a bluish white color, being half transparent, and is very 
apt to create alarm. Indeed, there is sometimes reason 
for alarm, for when this swelling is considerable, the skin 
cannot be pushed back over the penis, or, if pushed back 
it cannot be brought forward again, so as to cover it 
Now, there is not so much danger in this swelling itself, 
as in the consequences of it; for if the skin cannot be 
pushed back, the matter under it accumulates and becomes 
acrid and irritating, and you cannot avail yourself of clean- 
linesss, which is always of importance. And, on the other 
hand, if you cannot bring the prepuce forward, it pro- 
duces danger by acting as though a string were tied 
around the head of the penis, preventing the return of the 
blood, so that it swells prodigiously, looks blackish, and 
sometimes even mortifies and comes away. This, how- 
ever, can always be prevented by proper management, 
which will be shown as I have already said, in a fol- 
lowing chapter. It is called a Phymosis when the skin 
cannot be drawn back from over the gland, or head of 
the penis, as in the former instance ; and a Paraphymosis 
when, being back, it cannot be brought forward again 
over the gland. 

Swelling of the Glands in the Groin. 

This also is the result of inflammation, spreading to the 
glandular bodies situated in the groin. In every part of 
the body there are certain little vessels called absorbents; 
and these, in their course, run through absorbent glands, 



of which there are several in each groin. Now it hap- 
pens that inflammation in the urinary passage is commu- 
nicated through the medium of these vessels to the glands 
in the groin, which become painful and enlarged in con- 
sequence. It is however worthy of remark, that in Go- 
norrhoea, glandular swellings seldom go on to form an 
actual bubo (which is an abscess in the groin) as they 
are apt to do in Venereal Disease, so that they are com- 
paratively innocent; after a little time they generally 
subside and disappear, (see plate 3). Another of 
these occasional symptoms is 

Frequent and very painful Erections of the Penis. 
This is a distressing and tedious symptom, the nature 
of which I will endeavor to explain ; — in fact it is nothing 
more than inflammation extending from the lining mem- 
brane of the urinary passage into the substance and body 
of the penis ; and it seldom occurs unless the inflamma- 
tion runs high. The structure of the penis is remarkable, 
(see plate 1). It is made up of large cells, into w r hich 
the blood is determined under certain circumstances of 
excitement, and when these are filled, the penis is erect. 
Now the effect of the inflammation having passed into 
the walls or substance of the urinary passage, and into 
this cellular tissue, is to deprive these parts of their natur- 
al elastic, yielding nature ; they become thickened, tense, 
unyielding, so that when the blood rushes in, as we know 
it does under sexual and other kind of excitement, pro- 
ducing enlargement and elongation of the penis, these 



EXPLANATION OF PLATE I. 

Figure 1. A transverse section of the penis, exposing 
its internal Cellular or Spongy Structure, and the blood- 
vessels ramifying through it ; this is called an Erectile 
tissue. Erection of the penis takes place by the filling 
up of this spongy texture with blood which for a time is 
retained in it. It is seen that the spongy structure is in 
two separate masses, and forms the bulk of the body of 
the penis. The three or four small holes above are the 
blood-vessels running along the back of the penis ; — the 
larger hole underneath is the urinary passage — which is 
observed to have another spongy texture surrounding itse 1 
separately. The inner lining skin of the passage (th, 
seat of Gonorrhoea, &c.) is seen thrown into longitudinal 
folds, which enables it to expand or open when the urine 
passes, or when its spongy tissue is expanded during erec- 
tion. This is generally the seat of pain in Chordee. 

Figure 2. A highly magnified view of a portion of 
the Spongy or Cellular tissue. 



PLATE I 



Hk 




Figure 1. 





-=*V 



Figvre 2. 



EXPLANATION OF PLATE II. 

Figure 1. represents the Testicle, and attached to one 
side, the commencement of the Chord, composed of the 
Blood-vessels, Nerves, and Seminal Tube, i. e., the tube 
which conveys the Semen from the Testicle. 

Figure 2 shows a dissection of the Chord, in which 
everything is removed except the Seminal Tube itself; 
this is seen to be exceedingly small and delicate, and 
thrown into innumerable convolutions from the spot where 
it emerges from the Testicle at the top, and so continued 
til] it reaches the bottom, where it gradually becomes 
thicker and less intricate, at last ending in an almost 
straight tube : it has been unravelled and found to mea- 
sure no less than thirty-two feet in length. This delicate 
organ is the seat of disease in Swelled Testicle following 
Gonorrhoea and other inflammations of the urinary pas- 



PLATE II. 




Figure 1. 







Jf 




Figure 2. 



parts resist, are stretched with difficulty, or even torn, 
giving excessive pam. Sometimes, thus thickened and 
altered by inflammation they will hardly yield at all, the 
figure of the penis is then more or less crooked, as we 
often see ; the pain accompanying this is terrible. It is 
what is called Chordee, — the prevention or cure of which 
we shall presently come to, (Chapter in). The fourth 
and last of the occasional symptoms of a Gonorrhoea is 

Swelling of the Testicle 

This I consider a very important thing, for here the 
pain is so great, and the necessity of rest and lying in bed 
so urgent, that it is difficult to cure such cases with that 
secrecy which is so often desirable. Much however, may 
be done to prevent it, if early attended to, and therefore 
the symptoms which precede and lead to it, shall be no- 
ticed carefully. 

The first thing w 7 hich precedes a swelling of the testicle 
is a sense of pain running down the whole length of the 
urinary passage, accompanied w 7 ith a feeling as if a drop 
or two of urine were remaining in the passage after making 
water. To this there succeeds a dull pain in the groin, 
going on to affect the testiclej which presently feels heavy 
and very fender to the touch ; or, the pain and tenderness 
of the testicle may set in at once without any of these 
premonitory symptoms. No time should be lost. It 
should be attacked instantly, in order, it possible, to arrest 
the inflammation belore fuliv -tevetonetf 



The seat of the disease is not in the body of the tes- 
ticle itself, but in a small organ attached to it, (see platt 
11), which, in a healthy state can, by carefully feeling 
around the testicle, be discovered at its lower and bach 
part ; it is small, loose, and feels like a collection of fibres 
When attacked by inflammation it becomes exquisitely 
sensitive and painful to the touch, and swells rapidly, be- 
coming at the same time hard and solid; it will then 
often exceed in bulk the testicle itself. The treatment, 
will be found in Chapter in. 

Inflammation of the Bladder. 
Is stiil another consequence of the extension of the 
primary gonorrhceal inflammation — to the neck of the 
bladder. This part is naturally very sensitive, and, when 
inflamed, becomes so irritable that the contact of the 
urine or slight distention of the bladder gives rise to pain 
and desire to urinate. It may be slight, causing merely 
the inconvenience of too frequent micturition with diffi- 
culty of restraining it ; or, the bladder may empty itself 
every five or ten minutes, passing only an ounce or two 
of high-colored urine, with great pain, and followed by 
blood, the desire to urinate remaining unrelieved. It is 
then attended with fever. This affection oftener appears 
in a mild or sub-acute form, but may set in with great 
severity, and is then a most harassing and painful addi- 
tion to the Gonorrhoea, it is therefore prudent to use 
means tor its pretention or cure directly a tendency to it 
is observed, as direcieu in OLapter in. The position o* 



EXPLANATION OF PLATE TIT 

Showing the Glands of the groin, and the absorbent 
vessels coming from every direction to pass into them. 

It is the inflammation of these glands that constitutes 
Bubo. If, from any cause, one of these vessels is injured 
or inflammed, the inflammation generally passes along 
till the vessel merges into a gland, where it settles, caus- 
ing the gland to swell and frequently to suppurate. 
Thus, if a chancre on the penis or the inflammation of a 
Gonorrhoea happens to implicate one or more of these 
little absorbent vessels, several of which are seen passing 
along the penis and testicle, the effect is immediately 
transmitted to one or more of the glands of the 
groin, and Bubo, as it is called, is the consequence. 



PLATE III. 




^9 W^i 




v"il f 1 







3* 



the neck of the bladder, the seat of this inflammation, is 
shown in plate iv. 

This then, is all that need be stated on the nature, 
symptoms and progress of Gonorrhoea. With regard to 
its consequtijoes, tiiey are, indeed, severe and paiiiful, but 
there are other remote consequences which are of infinite- 
ly more importance, so much so as to demand separate 
and lengthened attention. The consequences to which I 
allude are Gleet and Stricture, which latter, growing 
as certainly out of Gleet, as Gleet does out of Gonor- 
rhoea, again gives occasion to a train of symptoms the 
most lamentable that can be conceived, of which Impo- 
tence is one. 

Does Gonorrhoea ever wear itself out ? 
Before I leave this subject, I would remark that many 
have put this question to me, — Does this disorder (Gonor- 
rhoea) ever cure itself? — does it ever wear itself out ? To 
which I have always replied, It may do so ; but it is a 
most terrible risk to run; for not only will it wear out 
the patience of the patient, but will leave open the widest 
door for the consequences I have just enumerated. The 
general consequence of a Gonorrhoea, if not early and 
properly treated, is a Gleet, and a Gleet implies a cer- 
tain morbid state of the urinary passage, which, if long 
continued, is almost sure to terminate in Stricture, a 
disease than which I know nothing that, in the hands of 
most people, is more baffling and truly lamentable 



CHAPTER II. 

On the Remedies in general use for Gonorrhoea; — 
How far they are to be depended on ; — To tohat parti- 
cular cases they are suited, — and, How to use them to 
the best advantage. 

The remedies for the cure of Gonorrhoea are very few 
m number and are pretty generally known, Notwith- 
standing this, however, their real nature is but little un- 
derstood, so that they are constantly misapplied. They 
are internal and external. Of the first, the Balsam of 
Copaiva and the Cubeb are the chief; the external or 
local remedies consist of lotions, used as Injections. 

The Internal remedies are vegetable productions, which 
in their properties very much resemble one another. All 
of them impart their virtues to the urine, w 7 hich being 
retained in the bladder, impress upon it their peculiar ef- 
fect, and this again is transmitted to the part which is the 
seat of the disease- — the urinary passage.* On the other 
hand, Injections are generally mineral substances, and 

* This has be?n repeatedly proved. severed near the scrotum : he conse- 
Whilst attending the Clinique of the quentiy urinated principally by this 
renowned Ricor ; , at the Hdpital des as tificial opening, and, at both this and 
V6ceriens, of Pari-?, I had an opportu- the natural opening, the gonorrheal 
nity of witnessing a raro and curious matter escaped. The Balsam of Co- 
case, very illustrative of this fact. A paiva waa ordered him, and in a few 
man was admitted into one of the wards days the discharge from the posterior 
(Salle 2 I believe) having a severe half of the urethra was entirely check- 
Gonorrhoea; he had, by an accident, ed, whilst from the anterior half it 
some year3 previously got his urethra flowed almost or qu tte as freely as ever 



consist of certain suitable stimulants, which are applied 
more immediately to the seat cf the disease by means of 
a Syringe. Both kinds of remedies are exceedingly valu- 
able in their proper places, but they are also, both of them, 
either useless or dangerous if improperly used or misap- 
plied. The object of this Chapter, therefore, is to explain 
their use and nature more particularly 

It should also be stated, there are other remedies which 
are occasionally wanted in the cure of this complaint, but 
not always; these are, chiefly, the common remedies re- 
quired to lessen pain and inflammation. Various things 
are used with such a view, but there are some which are 
far more suitable than others ; an account of these there- 
fore I will afterward subjoin, pointing out their proper 
use and dose, as well as making such other, observations 
on them as may seem required. The successful treatment 
of these diseases depends more especially on the right 
management of the remedies in any given case. 

The Balsam of Copaiva. 

This, every body knows, is very often given for the 
cure of Gonorrhoea; indeed, Balsam of Copaiva, as a 
remedy for Gonorrhoea is so well known, that whoever 
discovers to another he has taken it by the peculiar smell 
it gives the breath, is generally set down for one who is 
contaminated with Venereal malady. Balsam of Copaiva 
is, beyond a doubt the best of all the internal remedies, 
but it has its objections, and the circumstance just men- 



tioned is one of them. Another is, its extreme offensive- 
ness to the taste; and a third, its offensiveness to the 
stomach, so that it is rejected by vomiting, or, if not re- 
jected, it takes away the appetite and induces a degree 
of nausea which can scarcely be endured. Indeed, it is a 
medicine, to some, so perfectly obnoxious that tbey can- 
not even think of the time of taking it without nausea or 
vomiting. With respect to the two first of these objec- 
tions, however, (its offensive smell and taste), the latter 
of these may be avoided by taking it in Capsules, and 
the former partly so. These Capsules are small glutinous 
bags, which are closed, and contain a little of the Balsam. 
These little bags, when swallowed, are soon dissolved in 
the stomach, and thus the Balsam may be taken and its 
disagreeable taste avoided. The peculiar smell imparted 
to the breath, however, is not got rid of by this means ; 
for, especially when it disagrees, the stomach is continu- 
ally expelling wind, and this affects the breath offensively 
and is equally betraying. But_the most important of the 
objections to the Balsam of Copaiva (that of disagreeing 
with the stomach and digestive organs) is not avoided by 
this ingenious way of giving it; for when the Balsam dis- 
agrees, it does so whether it is tasted in the mouth or not. 
These things, therefore, taken altogether, are great ob- 
jections to the Balsam. But there are others still to be 
acquainted with. One is, the fact, that there are many 
persons in whom the Balsam of Copaiva has no effect at 
all in curing this disease ; and there are others in whom 



it will stop the discharge, so iuu 8 as it is taken, but the 
moment it is laid aside, the disease or running returns. 
Now it is of no use for either of these to take the Balsam, 
or to continue it alone, at any rate If such were to take 
a ship load of this medicine, it would never cure them. 
When the Balsam does good at all, it does so very soon, 
by lessening the discharge. A good rule in taking the 
Balsam of Copaiva is, to watch its effect, and if it do 
not, within two days, or three at furthest, very sensibly 
lessen the discharge, lay it aside, or add some other re- 
medy to the treatment. 

There is also a time when the Balsam of Copaiva should 
not be given ; this is when the inflammatory symptoms of a 
Gonorrhoea run high. We always look for more or less of 
such inflammatory symptoms at the onset of this malady; 
sometimes indeed they do not happen, but they should al- 
ways be prepared for. It is with this view we always give 
an active purge or two, and direct low diet and rest if it 
can be had, at the beginning of a Gonorrhoea. This some- 
times prevents altogether, and if not, it abates them. After 
an active purging medicine, therefore, if there is no great 
pain and heat in making water, you may begin with the 
Balsam; but if there is, it should be delayed, however 
many days it may require to modify these symptoms. 

Likewise, should you have commenced with the Balsam, 
and inflammatory symptoms at any time start up, lay it 
aside, and first abate these painful symptoms before you 



begin with it again. I know that some begin with Bal- 
sam of Copaiva under any circumstances, and many times 
with impunity; but I also know that when it has been 
given without attention to these circumstances, it has 
sometimes been followed by distressing and even danger- 
ous events, as inflammation of the bladder, testicles, &c. 

But notwithstanding the truth of these remarks, the 
Balsam of Copaiva, when it agrees, and it is convenient 
to take it, is a remedy of considerable power in the cure 
of Gonorrhoea. Sometimes it is trusted to alone, but 
then, for any chance of success, it must be taken in a cer- 
tain and well regulated manner, and cautiously abandon- 
ed. Let it be always remembered, however, that, where 
it can do good, it does so quickly; perhaps in two days 
the discharge is lessened one half, and it then goes on 
more gradually to diminish. But let it also be remem- 
bered that in those cases where it is equal to the cure 
alone, that cure would be affected in less than half the 
time if given in connexion with local remedies — Injections. 

If the Balsam of Copaiva is fixed on as a remedy for 
Gonorrhoea, it should be given in the dose of about a tea- 
spoon-full, not less than thrice a day. It may be taken 
simply in a little water, on which it floats like castor oil ; 
but generally it sets better on the stomach when made in 
the form of a mixture or an emulsion. If it happen to 
purge, omit it for a day and take a dose of Rhubarb. If 
this will not do, add to each dose of the Balsam four or 



five drops of Laudanum. It should be continued for some 
time after the discharge has ceased, and then left off only 
by degrees. This is all that need be said about the Bal- 
sam of Copaiva, 

The Powdered Cubeb. 
This is an admirable remedy if properly availed of, and 
is free from the offensive smell of the Balsam of Copaiva, 
it is also a pleasant, wholesome aromatic, and generally 
agrees with the stomach. Neither is there the same de- 
gree of objection to giving it in the very onset of the dis- 
ease (provided high inflammatory symptoms have not set 
in) as there is to the Balsam; indeed, such is its peculiar 
effect, that if given freely and early, it sometimes super- 
cedes the inflammatory symptoms altogether, and leads 
to a very speedy cure. If, however, inflammatory symp- 
toms have already suddenly come on before you have had 
an opportunity of using the Cubeb, it is then more safe 
and proper to reduce these sj^mptoms by rest, purging 
and diet, before you venture on this remedy. So also, 
if you had begun early with the Cubeb and such inflam- 
matory symptoms should happen to arise, let it be discon- 
tinued for a while, or until these symptoms have been 
abated by the means above referred to, and then resume 
the Cubeb. 

The best way of taking Cubeb is in the dose of a j 
piled-up teaspoon-full, mixed in a tumbler of water, and 
repeated twice or thrice a day. It is of no use to take it 



in small doses, as many do. There is something also in 
the manner of taking it. The best way is to fill a tumbler 
half full of water, then put a teaspoon-full of the Cubeb 
upon the water, and in a minute or so it will have sunk 
from the surface to the bottom, and thus is equally dif- 
fused ; you then give it a stir and drink it off. 

Should the Cubeb irritate the bowels as a purgative, 
this may be checked by adding five drops of Laudanum 
to each dose; but if it only prove a little laxative, to this 
there is no objection. The virtue of the Cubeb should 
be separated by the kidnies and carried into the bladder, 
and of this you may always be assured w T hen a peculiar 
smell is imparted to the urine, — a kind of violet smell, — 
not unlike that which the urine has on taking turpentine, 
or when an individual has been exposed to breathing the 
atmosphere of a newly painted room. 

But, although I have said so much in favor of the Cu- 
beb, let it not be thought that it is to be depended on in 
every case. On the contrary, there are many individuals 
in whom it seems to have no good effect at all ; and others 
in whom it will stop the discharge so long as it is con- 
tinued, but the moment the remedy is laid aside the dis- 
ease returns. And what was said of the Balsam of Co- 
Daiva is also applicable to the Cubeb; — viz., when it 
does any good at all, it does so quickly ; so that if you 
do not see the most decided advantage from its use in two 
or three days, but little or none is to be expected fiom & 



EXPLANATION OF PLATE IV. 

The various medicinal substances taken into the sto- 
mach for the purpose of acting upon the urine and the 
urinary organs, can only reach these along with the cur- 
rent of blood, into which they have been absorbed, as it 
passes from the main artery of the body into the Kidnies 
by 

A, A, — The Renal Bloodvessels. During the circu- 
lation of the blood through B, B, the Kidnies, the refuse 
matter destined to form the urine, as well as certain 
medicinal substances, is seperated from it, and passes in 
the form of urine along 

C, C, — The Ureters, into 

D, — The Bladder, or reservoir of the urine. 

E, — Is the Prostrate Gland or neck of the bladder, and 

F, — The Urethra or urinary passage, which, with the 
bladder and prostrate gland, are represented laid open. 



PLATE IV 




The inconvenience of its bulk, and the mode of taking 
it, are also in some cases a great objection to the use of 
the Cubeb. 

The virtues of the Balsam of Copaiva and the Cubeb 
have now been fairly stated, and the objections to them 
shown. To this again must be added their uncertainty, 
for, in many cases they entirely fail. The fact is, that 
many cases of Gonorrhoea defy the virtues of internal 
medicines alone, and absolutely require the aid of local 
remedies, injections, with which, judiciously and skill- 
fully managed, the cure is accomplished in less than half 
the time, and is far more safe and certain. 

In cases of unusual difficulty or obstinacy, other local 
applications are used, but they can only be used under 
the immediate direction of the surgeon; they could not 
therefore be properly described in a work of this kind. 

Injections. 
The use of these forms an invaluable part in the treat 
ment of Gonorrhoea, — it is applying the remedy to the 
disease itself — the advantage of which can scarcely be 
doubted. Yet there are some who are opposed to Injec- 
tions, simply, as it would seem, because they may be 
abused. But carry on this reasoning to other diseases — 
say Ophthalmia, for instance. Internal remedies, then, 
are very good in Ophthalmia, and sometimes will cure it, 
but who would withhold the use of Lotions and other ap- 
plications to the eye itself, simply because they may be 



misused or abused. Is there a single medicine which 
may not be abused? Quite the contrary, — and the most 
valuable too are the most capable of such abuse. Oh I 
it is said, they may cause a Stricture ; and so may Lo- 
tions and Ointments put out the eye; but, if properly 
used, they will save the eye, and cure its malady, and 
this in less than half the time it could be cured without 
them. Indeed there are many cases of the eye that can- 
not be cured at all without them, and so of Gonorrhoea. 
As to the idea of Injections causing Stricture, nothing 
can be more ridiculous; for, on the contrary, they prevent 
it. The ultimate result of a Gonorrhoea, long continued, 
is Stricture. Gonorrhoea implies a certain virulent or 
specific inflammation — this is its essential nature, — the 
ultimate tendency of which is to destroy the elastic prin- 
ciple with which the urinary passage is naturally en- 
dowed, and in this consists Stricture. Whatever shortens 
the duration of a Gonorrhoea, therefore, lessens the chance 
of a Stricture. Now, Injections shorten the duration of 
Gonorrhoea, — they therefore prevent Stricture. 

If another argument were required, I might adduce the 
fact that Injections are used and recommended by the 
greatest surgeons in the world. This, however, is quite 
unnecessary, — it is enough to state that, although inter- 
nal remedies alone will sometimes cure a Gonorrhoea, yet 
they sometimes totally fail; also, that in those cases where 
internal remedies are sufficient to the cure alone, that cure 
can be accomplished far more safely and certainly and in 
* A 



less than half the time if aided by Injections. It would 
therefore seem superfluous to say another word upon the 
utility of Injections, — it now only remains to show then 
proper use. 

Injections should not be used in the very early or in- 
flammatory stage of Gonorrhoea ; and even when this is 
past it is better to begin the cure with internal medicine, 
and continue for a day or two, before resorting to Injec- 
tions. After this you may use them safely and very ad- 
vantageously, few Gonorrhoeas can long hold out against 
their proper use. 

Injections should not be used too strong. It is no dis- 
advantage if they give a little tingling sensation, but if it 
amount to heating pain their strength should be reduced 
by adding a greater portion of water. It is net proper, 
either, to increase the strength of an Injection to any 
great degree, but rather, if it seems to do no good, to 
change it for another. So if any one has been useful, but 
after a time should seem to lose its power, it would be bet- 
ter to change it for another than to increase its strength. 
Injections will sometimes lose their good effect, and for 
this reason several recipes are given for them. Indeed, 
under any circumstances it is better to change an Injec- 
tion now and then — the part becomes accustomed io the 
peculiar stimulus of one alone if long continued, — the dis- 
ease is sooner baffled and destroyed when one correcting 
stimulus is exchanged for another. It is better therefore 
to change an Injection ; you may return if you please to 



the one you used at first, if that agreed, onlj change is 
now and then — keepiDg most to that which best agrees. 

Injections are chiefly mineral ; there is a great variety of 
them, but they all act pretty much on the same principle ; 
some however are better than others ; the most useful and 
most generally employed are the Sugar of Lead, the White 
Yitriol, the Alum, the White Vitriol and Alum combined. 
Laudanum is often added, especially when it is wished to 
allay irritability in the urethra or to prevent the irritation 
these chemicals sometimes cause. It should be recollected, 
always, that it is not so much the strength, as the effect of 
change of Injection ihat is here insisted on. The Blue 
Vitriol is sometimes used for Injections, but it is apt to dis- 
agree — irritating the passage, giving pain and increasing 
the discharge. It is, however, sometimes excellent on this 
very account — when a discharge is becoming stationary, 
getting neither better or worse with the other Injections, this 
perturbing effect is often useful, and, after using it a few 
days and then returning to the other, you will find an evi- 
dent improvement immediately takes place. 

Catechu, Tannrin, Sulphate of Morphia, Acetate of Zinc, 
Tahnate of Quinia, Iodide of Iron, &c, &c, are used as- 
Injections ; but these require experience and skill in their 
management : indeed, more depends on the skillful manage- 
ment of the applications in form of Injection than upon the 
particular preparation used — this is especially true in the 
instance of Gonorrhoea. 

Injections, to secure their greoi utility, require attention 
to the manner and frequency of using them. Many times 
I have heard it said, " The Injection does no good," when 



I have found upon inquiry that it had not been made to 
enter the urinary passage. Of course it must then fail. 
To use an Injection properly it must pass up a certain 
distance. No matter how much further, but it must go 
up at least several inches, and it should be kept and 
retained there for a minute or two, by pressing the top 
of the penis with the thumb and finger. The sensation 
an Injection gives is quite enough to tell whether it has 
properly entered — it is as if you wanted to pass out urine ; 
but the proof of it is, that a teaspoon-full or so squirts 
out again when you let go your thumb and ringer. To 
insure an injection running well up the passage it is also 
necessary to hold the syringe firmly enough into the ori- 
fice to prevent any escaping that way. With respect to 
the repetition of their use, this too is an important point, 
— much depends on their regular frequent repetition. 
An Injection should be used six or eight times in the 
twenty-four hours : every two hours or every hour and a 
half if you please, provided it does not irritate or pain ; 
but certainly not less than I have stated. The common 
syringes sold for using these Injections are often much 
too small; this is particularly the case with what are 
called the pp syringes; and the nose or spout is also 
made much too long, passing half, and even an inch or 
more into the passage, which proves a scource of irrita- 
tion to that part. A syringe should be chosen, therefore, 
with a very short spout, and it should hold about or 
nearly half an ounce of liquid. 



The preceding remarks relate exclusively to the reme- 
dies in common use for the cure of Gonorrhoea. But, it 
was mentioned, there are other medicines now and then 
required — these are, chiefly, the common remedies in use 
for abating pain and inflammation. To make this little book 
complete, it is necessary here to enumerate these, and say a 
word or two on the dose and proper use of each. 

Lotions. 

These are often very useful, and are generally employed 
to assuage inflammation, as, for instance, in the case of 
swelling of the prepuce, or of the penis itself, in swelling of 
the testicle, &c. They are always used externally, and ap- 
plied by means of rags soaked in the liquid and laid on or 
wrapped round the inflamed part. 

The manner of making and applying them will be found 
in Chapter in, Note. 

Cooling or Diluting Drinks. 

These reach the urine through the same course as de- 
scribed at Plate iv. They are useful in any case, and, 
where there is much inflammatien, with heat in micturition 
and high-colored scanty urine, they become very necessary. 
When they are required it is important to know what are 
the best, and how to make them. But it sometimes hap- 
pens a person is so circumstanced that he cannot procure 
these — the request to have them prepared would lead to 
inquiries as to what they were wanted for. To such there- 
fore it will be satisfactory to know that they can be done 
without. The softening mucilaginous qualities of which 



they are composed, certainly have their use, but this is no- 
thing compared with their diluting quality — depending en- 
tirely on the water in which they are dissolved. If, there- 
fore, you take a watery drink of any kind, as common 
water, the end is answered — that is, if you take plentifully 
of it. A near approach to these mucilaginous drinks, how- 
ever, can be easily and pleasantly made. Take an ounce 
or more of Gum-Arabic, in large lumps, in the waistcoat 
pocket, and consume it during the day in addition to plen- 
tiful drinking, by taking a lump into the mouth every now 
and then ; or Jujube Paste may be used instead of Gum 
Arabic ; it is a very pleasant thing, and gives to the simple 
water the softening effects of the various drinks, viz. : Flax 
Seed or Slippery Elm Tea, Barley Water, &c. 

Purgatives. 

Next to bleeding, purgatives form the most active agent 
in reducing inflammation. 

Opium. 

It is a valuable medicine under many circumstances, and 
is sometimes required in the accidental symptoms of 
Gonorrhoea. 

Senna and Salts is an excellent purgative medicine, either alone or 
taken in the morning after any pill the night before. 

Take one ounce, or about a handful of Senna leaves, pour on it a pint of 
cold, soft water, put it on the fire — taking care to remove it the moment 
it boils — stand on the leaves till cold — then strain off, and to the liquor add 
one ounce of Epsom Salts, or two ounces of Rochelle Salts. A tittle bruis- 
ed ginger boiled with the leaves prevents griping. Dose a large wineglass- 
full and repeated every half-hour or hour till it operates. 

Jalap and Calomel. — Fifteen grains of the former and five of the lat- 
ter, taken in sugar or molasses. A larger dose is sometimes given. 



Epsom Salts and Antimony. — Dissolve two ounces of Epsom Salts and 
two grains of Tartarized Antimony in half a pint of water, and take a 
wineglass-full of it two or three times a day, or as often as may be necessary 
to keep up a moderate degree of purging. 

Epsom Salts is a good cooling purgative ; an ounce is the usual dose, 
taken in water. This is the purgative that most people take on finding 
they have got a Gonorrhoea. It is not however the best ; for much of 
that quantity of salt passes through the bladder — adding to the saline ir- 
ritating quality of the urine, and thereby increasing the scalding pain in 
urinating. It is better to take one of the other purges above, but this 
will do if no other is at hand. It is not generally known that a very small 
quantity of Epsom Salts, if taken in a larger quantity of water, will act 
more pleasantly, certainly and effectually than a larger dose in the usual 
quantity of water. A teaspoonful for instance, in a tumbler of water, in- 
stead of an ounce in a teacup-full of water. Also, by repeating this 
weaker solution of salts it is a very cooling and proper medicine in a hot 
and feverish state. But the best of all medicines for cooling and reducing 
the system is the combination of Epsom Salts with Antimony just men- 
tioned. 

Seidlitz Powders is a pleasant way of taking a mild dose of saline 
medicine. 



COOLING, OR DILUTING DRINKS. 

BaPvLey Water. — To make this properly, take a teacup-full of pearl 
barley, boil it a few minutes, then throw away this dirty water, and add 
to the pearl barley three quarts of fresh water, and boil it down to two 
quarts. Some add a few figs or a little liquorice root towards the end of 
the boiling. Dose, a tumbler-full as often in the day as possible. 

Flaxseed Tea. — Take of whole flaxseed (not of flaxseed meal) two 
ounces or three or four table-spoons full (there is no occasion to be very 
exact in quantity) and add to a quart of water, which is to stand simmering 
by the fire for an hour or two — then strain and, if more agreeable sweeten 
it. Let at least this quantity be taken as common drink during the twenty- 
four hours. 

Alkaline Drinks. — Another excellent remedy to abate the pain and 
heat in making water is the Super-Carbonate of Soda. Procure an ounce 
of this, and dissolve one quarter of it in a quart of common tea, or in plain 
water : it may be sweetened. This quantity should be taken during the day. 

Or, the same quantity of Soda may be added to the barley-water or 
flaxseed-tea, which would increase their soothing effect. 

If these cannot be had, a little Gum- Arabic or Jujube Paste may be con- 
stantly kept in the mouth — remembering to drink frequently and freely of 
water. 

Soda Water is also a good remedy and resembles the Alkaline drink. 
It must however be that made from the Soda powders, and not that drawn 
from the fountains, which contains no soda and is merely a pleasant aerated 
water. 



A 



s 

v. 

IF 
i 










«9 



<3 





CHAPTER III. 

On the Accidental Symptoms of Gonorrhoea, viz: — 
Excessive pain and heat in making water : 
Swelling qfthePrepuce, — Phymosis and Paraphymosis; 
Frequent and painful Erections, — Chordee ; 
Swelling of the Glands in the Groin, — Bubo; 
Swelling of the Testicle. 

The nature of these Accidental Symptoms has been 
sufficiently explained, in the first Chapter; to avoid use- 
less repetition I shall therefore at once proceed to de- 
scribe their treatment and cure. 

Excessive pain and heat in making water. 
This is nothing more than a higher degree of the first 
or inflammatory stage of Gonorrhoea which has been al- 
ready noticed, but which must be subdued before the 
remedies for stopping the discharge are entered on. The 
means of reducing inflammation are, — purging, low diet, 
rest, and the freest use of diluting drinks, for which di- 
rections are given elsewhere, and Notes 1 and 2. 
You cannot make too free a use of diluents. The burning 
pain arises from the saline urine passing over an inflamed 
and irritable passage. The urine itself is loaded with 
salts — it is like brine; if, therefore, you dilute it with 
one of the cooling drinks, or even with simple water, it is 
easy to imagine how its irritating property must be di- 
minished. Sooner or later by the means above directed, 






this heat and pain will considerably abate, and then, and 
not till then, can you safely proceed to lessen the discharge 

Swelling of the Prepuce. 
The Prepuce (called also the foreskin) will often swell 
prodigiously, but this, of itself, is of very little conse- 
quence. A soft rag wet with brandy and water, or any 
of the Lotions given below, Note 6, and wrapped about 
the part, together with a dose or two of purging pills, is 
all that is required. The rag should be wetted often. It 
is of some advantage too if the penis be kept upright, 
which is easily done by pinning or fastening it to a band- 
age around the waist 

But the swelling sometimes is so great that the pre- 
puce cannot be pulled back from over the head of the 
penis, — this condition of it is called a Phymosis; — and 
sometimes again, when it is pushed back it cannot be 
drawn forward, — this is called a PGraphyynosis. Now 
both these states are of great consequence, particularly 
the latter. 

In the first, Phymosis, the chief thing to look to is 

NOTE Lead Lotion — Sugarof Lead a quar. 

Cooling Lotions. * er + of an ounc , e > S r oft water °™ ^ £ 

a teaspoonlul of vinegar should bt 

Evaporating Lotion. — A quarter of first put into the water: used as the 

a pint of Alcohol (brandy or other spi- above. 

tits may be substituted) in three quar- Evaporating Lead Lotion. — Sugar 

ters of a pint of water. The best way of Lead a quarter of an ounce, Alcohol 

to use it is to apply a fold or two of a quarter of a pint, Water three quar- 

linen upon and around the part, and ters of a pint. The Sugar of Lead, 

keep this wetted with it. The part with a little vinegar should be dis- 

should be otherwise covered up as lit- solved in the alcohol before adding the 

tie as possible. water ; used in the same way. 



cleanliness, and here a Syringe, either a common one or 
the pocket Syringe particularly described at page 43, 
will answer, is of the utmost use in washing out the 
humors that collect beneath the prepuce, and which, by 
becoming acrid and offensive, greatly increase the malady. 
It is necessary therefore to inject some proper fluid un- 
der the prepuce several times a day. Anything that will 
wash away these humors is better than nothing, so that 
warm or even cold water may be used; but the best 
thing for this purpose is a lotion made of the Lead, in- 
jection powders, or the lead Lotion in Note for these 
are cooling and healing to the parts, as well as cleansing. 

The Paraphymosis is still of more consequence ; in- 
deed you should lose no time in endeavoring to reduce it, 
that is, to bring the prepuce forward again over the head 
of the penis. With this object you proceed in the fol- 
lowing w T ay : Take hold of the head, which is always 
very much swollen, with the fingers and thumb, and 
steadily press it ; gently increasing the pressure in order 
to squeeze back some of the stagnant blood and lessen its 
size. It is better if you first hold the hand in very cold 
water. Immediately after thus diminishing the size of 
the head, apply the tw T o thumbs to it, and grasping the 
prepuce w T ith the fingers, steadily push back the head 
wiiile you pull the prepuce forward. A little force may 
be necessary, but you will almost always succeed; if not, 
the only thing a surgeon can do, would be to cut the skin 



on each side, where it is tightest, and then it will easily 
pull over ; this might be done with a sharp pen-knife or 
razor, after this applying a common poultice. In both 
these cases, of course, it would be proper to live low, 
keep as quiet as you can, and purge freely. 

Frequent and very painful Erections of the Penis. 

This is what is called Chordee, and a very painful 
thing it is. I have already pointed out its nature in the 
first Chapter, Plate it occurs particularly at night — 
the penis often being quite crooked at these times. When 
Chordee is disposed to come on, it cannot always be pre- 
vented entirely, but it can always be relieved and ren- 
dered tolerable. Further, a Chordee once come on, it is 
often the last symptom to leave the patient. 

The best way to prevent a Chordee from coming on is 
to prevent inflammation, by rest, purging, and low diet ; 
the best way to relieve it when it has come on, is to take 
two or three of the Anodyne Pills, which are probably 
the best, or any other in Note at bed-time. After 
a few nights, see if you can leave them off, but if the 
pain comes on again, return to them. With a view also 
of relieving the inflammation of the penis, on which this 

NOTE —the dose fa from two and a half to ten 

oputes. e raiD8 - 

Opium Pills. — Gum opium one grain, 
made into a pill. 

Laudanum. — Of this the do*e is from 
five to thirty drops, in a little water; to 
be repeated until relief is obtained. 

Dover's Powder is given to assuage 
paiu— it is a soothing and fever medicine 



symptom depends, it is a good thing to immerse it in a 
basin of hot water for a quarter of an hour on going to 
bed. and afterward to wet a soft rag with brandy or vine- 
gar and water, or common water, or one of the Lotions 
in Note and wrap it round the penis. Some contrive 
to have a bottle of cold water near the bed, which they 
hold between their legs whenever it awakens them. 

Swelling of the Glands in the Groin. 
This is of less consequence in Gonorrhoea than in Ve- 
nereal disease ; — it is a very rare thing in a Gonorrhoea 
for these swellings to form into matter and break 5 as they 
do in Venereal. Brisk purging,f as much rest as pos- 
sible, and at night, a rag wet with brandy and water, or 
vinegar and water, or any of the Lotions just named, 
especially the third, laid on them, is all that is required ; 
under this plan these swellings almost always subside. 
I have indeed sometimes seen them form matter and 
break, but it has always been owing to the constitution 
rather than the Gonnorrhoea. In such a case, should 
these tumors threaten to form matter, leeches would be 
proper and desirable; or, which may be very much de- 
pended on, a small blister of Spanish fly about the size of 
a dollar piece. Secure it over the swelling at bed-time, 
and remove it in the morning, dressing with a bit of rag 
spread with lard ; it may be repeated two or three times, 
or at once followed by the Lotion. But do not at any 
rate omit the purging Or sometimes, if very incon- 



II 



venient to get the blister, the Liniment in Note 9, p. 71, 
may be used ; it should be well rubbed in — till the skin 
becomes quite sore and red — once or twice a day. 

Swelling of the Testicle. 
When this complaint happens, it generally begins about 
ten or fourteen days from the commencement of the dis- 
charge, but it may occur at any time. At first there is an 
uneasy feeling about the part which you might judge to 
be the situation of the neck of the bladder — just behind 
the Scrotum (the purse). Then there is a swelling of 
the back part of one of the testicles — it is seldom both 
are affected at once, thongh one may be after the other — 
frequently with great pain, and fever. From the moment 
a testicle is threatened by these symptoms, give up every 
means for the cure of the Gonorrhoea and turn your whole 
attention to this single circumstance. 

In the cure of this affection, the first thing to be re- 
commended (when it can be done) is rest, and resting on 
a bed is preferable to any other. The next, to support 
the testicle by means of a suspensory bandage, which may 
generally be obtained at any apothecary's store. If you 
have not this at hand, it may easily be contrived. — Make 
a bag of soft linen, large enough to hold the swollen parts, 
and then sew or pin it to a bandage or pocket handker- 
chief round the body. If the testicle is suffered to hang by 
its own weight, this alone will prevent its cure and greatly 
augment the pain. Next take five or six purgative 






pills. Frequent and repeated purging is a powerful means 
of relieving this disease, and this may be followed up 
either by repeating the pills, or doses of Epsom Salts, or 
Senna Lotions also are of great use, and the best of 
all is the third one in Note but any of those will do, 
applied by keeping a soft rag, and the suspensory band- 
age, constantly wetted with it. Bleeding by leeches is 
exceedingly useful where the pain and inflammation are 
great, but many persons are placed in such circumstances 
as not to admit of their use. There is, however, another 
way of taking blood from the part, which might be 
resorted to in very urgent cases, or might be practised 
at sea, where leeches are not always to be had — it is as 
follows: t Stand before a warm fire and pull up the 
scrotum so as to put the skin on the stretch ; you will 
then see several veins of a blue color: — Take a lancet or 
very sharp pointed pen-knife and puncture five or six of 
them : — then, with a sponge and warm water, bathe the 
part, and you will be able to get more blood than by 
leeches, and with far less trouble and risk of exposure. 
The bleeding ceases on laying down; if not, applying 
fold water will soon stop it. Sometimes, even under the 
best possible treatment, great pain and inflammation will 
continue, and you are under the necessity of taking opi- 
ates. Forty or fifty drops of laudanum may be taken at 
bed-time, followed by a purgative draught in the morn- 
ing. The best form, however, of opiate medicine is, if it 



can be procured — fiifteen grains of Dover's Powder, with 
two of calomel at bed-time. This is as far as I would 
advise any one to go on his own judgement. In ver) 
many cases these means will stop the progress of this 
symptom, and indeed remove it; but, on the other hand, 
there are some cases in which it will not ; the pain goes 
on and is attended with fever and perfect inability to go 
about. In this case I would advise, if posible, to call in 
medical assistance ; but, in many cases, this is quite im- 
possible : you may be at sea, or in the country, or where 
you cannot obtain this assistance, and therefore I will 
pursue this subject and describe the best measure to adopt 
in such a case, in Note 



NOTE 

If rest, low diet, purgative medi- 
cines, lotions, and perhaps leoches to 
the p:irt, (Jo no:, succeed iri lessening 
the pain and inflammation, then copious 
^deeding should beje>oited to Indeed 
bleeding would be proper in an}' case, 
but we do not always have recmrse to 
it, hoping to succeed with the moans be- 
fore mentioned. From one to two pints 
ofblood may be tal- en from the aim and 
repeated if not successful in allaying the 
pain, swelling, and fever. At the same 
time large doses of Tartarized Antimo- 
ny should be taken. Eight grains may 
be dissolved in lv<lf a pint of water, and 
an eight part of this may be taken evrey 
6econd or third hour. This is a large 
dose,— at first it may vomit or purge, but 
this shouid be no objection to continuing 
it, unless the vomiting should be. exces- 
sive . it will generally cease after a day. 
There is no medicine which has such 
power to subdue inflammation, and es- 
pecially inflammation of the Tes-ticle, 
as Taitarized Antimony, and so iinpor- 
tanl and so painful is this inflammation, 
that a liftLfi inconvenience or nausea and 
vomiting should not hinder from its use 
and benefit If the pain should be very 
great, and prevent sleep at night, three 
or four of the Anodyne Pills may be ta- 
U«*q it I'ed-time or "twenty eralae of Do- 



ver's Powde-, with two grains of Calo- 
mel, followed by a purgatfte diaughtin 
the morning. If this is not at hand, forty 
or fifty drops of Laudanum may be sub* 
stituted Leeches are always of use ;— 
fifteen or twenty on the part and after 
wards cover with a warm poultice At 
other times, if it can be, ice may be used. 
Sometimes cold applications will do 
when warm ones will not; at others 
warm will answer whencold will not If 
one has been tried without success, al- 
ways try the other. When ice is used, 
let it be bruised and put into a bladder 
half full of water and lay it on the in- 
flamed and swollen testicle It is aston- 
ishing how quickly this will som'times 
relievelb.epa.in and inflammation. There 
is a way of obtaining cold when you can- 
not procure ice Just mixequal parts of 
Sal almoniac Saltpetre, ami Glauber 
Salts, and put into ab'adderofwatei in- 
stead of ice; as these dissolve, much 
cold is produced I have dwflt longer 
on this subject than on some, as it is a 
severe complaint I have found it so in 
my practice A summary of the treat- 
ment of inflamed testicle then is as fol- 
lows. Suspend the testicle,— rest. — 
purge,— leech,— and apply cooling lo- 
tious. If pain, inflammation and fever 
still iim on,— bleeding, leeches, Tartar- 
ized Antimony, and the applcatioa of 
cold. 






CHAPTER IV. 

On Gonorrhoea in the Eyes and Gonorrhceal Rheu- 
matism. 

§1. 

Gonorrhcea in the Eyes, or Gonorrhceal Ophthalmm. 

This subject is introduced, not for the purpose of in- 
ducing a patient to undertake the cure of these complaints 
himself, but of apprizing him of their real nature and 
dangerous tendency, particularly the former, and urging 
him to loose no time in securing that surgical and prompt 
advice they need. Fortunately, these complaints are not 
of every day occurrence. Now and then, however, a 
person who is under treatment for a Gonorrhcea will be 
suddenly seized with a most severe Ophthalmia. This 
complaint runs on with great rapidity, and if not speedily 
arrested, it accomplishes the total loss of sight. It 
begins with great severity of pain and copious discharge 
of matter. In such a case there is not a moment to be 
lost : the advice of a surgeon should be sought. But as 
it is possible, and especially if the physician or surgeon 
have practiced principally in the country, that he may 
not have seen many cases of this kind ; and also for the 
benefit of those who may be at sea, and cannot obtain 
the advice and assistance of a surgeon; or, again, for 
hose who may be obliged to wait some time for his. 



arrival, I will give in the form of a Note ( ) an outline 
of the treatment which is recommended by the most ex- 
perienced and competent men in Europe. 

With respect to the manner in which the eyes become 
affected with Gonorrhoea, there has been a difference of 
opinion. Three explanations have been given to it. 
First, that it was owing to carelessness, such as inadver- 
tently rubbing the eyes with the fingers after handling 
the penis under the discharge of Gonorrhoea ; next, that 
it was owing to the Gonorrhoea affecting the constitution, 
when, like Rheumatism, it may change its seat from place 



NOTE 

fen Mackenzie's Practical Treatment 
of the diseases of the Eye, he directs 
the following for this kind of Ophthal- 
mia. •'Abstinence from all stimulants; 
blood-letting, : oth general and local; 
and the exhibition of purgatives, or 
emetic purgatives, and diaphoretics, are 
to be had recourse to in the early stage." 
The discharge is to be frequently and 
carefully removed by injecting under 
the eyelids, a lotion, made with a grain 
of the Muriate of Mercury to an ounce or 
more of water ; the globe of the tye is to 
be touched once or twice a day with a so- 
lution of Lunar Caustic, (four grains to 
an ounce of water; or six grains of Blue 
Vitriol to an ounce of water These 
are to be used with a camel hair pencil). 
Also, the lids are to be kept from ad- 
hering by anointing the edges of them 
with the red precipitate Ointment 
"Counter-irritation ought to be employ- 
ed from the very first, by means of mus- 
tard poultices and blistc. s to the nape of 
the neck, between the 6houIdors or be- 
hind the ears." "If the pain of the eye 
is pu'sative, or the parts around it are 
affected with pain coming on at night — 
Calomel and Opium should be given, 
so as to affect the mouth. Warm fo- 
mentations the vapor of Laudanum, 
opiate friction of the head, and the like 



will seem to moderate the pain; but our 
chief reliance must be placed on deple- 
tion,counter-irr;taiion, scarification and 
smarting application to the globe o: the 
eye itself, for removing the disease. 
Snipping out a portion of the chemosed 
membrane, (the outer membrane of the 
eye, whoso vessels are gorged with 
blood), so as to procure a considerable 
flow of blool is highly serviceable." 

" Bleeding alone must not be depen- 
ded on." 

••This inflammation," says Mr. Bai> 
cet, anothereminentand practical man, 
" in the few instances that have come 
under my observation, is of the most 
violent and intractable description, and 
has produced the total destruction 
of the organ of vision, in the space of 
two or three days, notwithstanding the 
most vigorous employment of general 
and topical bleeding, and other antiph- 
logistic means." 

To the truth cf this 1 can attest, upon 
the ground of my own experience, and 
I judge it therefore exceedingly desi- 
rable that persons should be aware of 
the dangerous nature and rapidity of 
this complaint, that they may not be 
induced to trifle away the only chanco 
of cure, for it is on the prompt and 
decisive treatment in the early stage 
alone that the invaluable sense of sight 
depends. 



to place j and thirdly, that it was the consequence of stop- 
ping the discharge of Gonorrhoea too suddenly. 

Respecting the two latter explanations, these certainly 
are possible but very doubtful causes. With regaid to 
the former, that is, inoculating the eyes by applying Go- 
norrhoeal matter to them, this, beyond a doubt, has been 
known to be a cause. 

These facts stand upon unquestionable authority, and 
in order that others may judge correctly and be careful 
on this point, I will relate an instance or two in Note 

With respect to the question whether or no there are 
such diseases as Ophthalmia from two suddenly stopping 



NOTE 

Mackenzie, on diseases of the Eye, 
page 844 states; "A patient was 
Drought to me from the country with 
violent Ophthalmia. This patient hav- 
ing Gonorrhoea, while engaged in re- 
moving the discharge from the urinary 
canal, a drop of the Gonorrhceal fluid 
was by mischance thrown fairly in 
upon his left eye, and excited the se- 
vere puro-mucous Ophthalmia under 
which he was laboring. The Gonor- 
rhoea stiil continued when I saw him. 
The inflammation of the eye subsided 
under appropriate means, the eye clear- 
ed to a degree far beyond my expecta- 
tions, and a considerable share of vis- 
ion was preserved." 

Mr. Allan relates the following re- 
markable case. "A gentleman, aged 
17 years, had had a Gonorrhoea a few 
days, when violent inflammation of the 
eye, attended with a discharge similar 
to that from the urinary canal, burst 
forth. The Gonorrhceal running from 
the penis continuing unabated at the 
same time. In a few days his brother, 
aged 14, who never had hsd Venereal 
diseases in any way, but who slept in 



the same room, was attacked with a 
similar Ophthalmia in both eye6. In ad 
dition to my own attendance Drs. Munn 
and Mr. Js. Beil, of Edinburgh, were 
called in, and, notwithstanding every 
means that could be devised, the elder 
brother lost the sight of both his eyes, 
and the younger brother of one. No 
doubt the younger used the same tow- 
el, or wash-hand basin, or the like " 

Again, the very eminent and practi- 
cal Astruc relates a case exceedingly 
in point " A young man had been ic 
the habit every morning of bathing hia 
eyes with his urine while it was yet 
warm, in order to strengthen his sight. 
Although he had contracted a Gonor 
rhesa, he did not abstain from this cus- 
tom, apprehending no harm from it ; 
but the urine partaking of the infec- 
tious matter, quickly communicated 
the same disease to the conjunctiva 
(the mucous membiaine which lines 
the eyelids). The consequence was 
a severe Ophthalmia, attended with aD 
acrid and involuntary discharge oi 
tears and purulent matter, but which 
yielded to the same remedies which 
removed the Gonorrhoea." 



the discharge of Gonorrhoea, and Ophthalmia arising from 
the constitution imbued with Gonorrheal disease, it is not 
necessary here to determine; many persons think there 
are, and I have no proof to offer that it is not so ; more- 
over, the cases we occasionally meet with here and there 
in the various periodicals would seem to corroborate such 
opinion. As 1 have already said, however, if there real- 
ly be such cases, they are very rare, and I have no doubt 
that many of those cases of Ophthalmia, as well as Rheu- 
matism, which are there related, have been diseases which 
happened to occur at a time when the patient was labor- 
ing under a Gonorrhoea, and had really no other connex- 
ion than their accidentally occuring at the same time. 
But, as I have said, as some persons think otherwise, I 
will give in the following Note, , (principally for the 
perusal of medical men) the peculiar treatment which such 
persons have adopted who have thus thought. 

NOTE of the bougie may perhaps produce 
the eflect so much desired ; for any 
Treatment of those cases of Oph- stimulus applied to the lining mem- 
{halmia which are supposed to arise brnne of the urethra, provided it be 
from too suddenly stopping the dis- of sufficient activity to determine 
charge — Of comse this kind of an irritation and a secretion of mu- 
Ophthalmia includes only that in cus, may produce a running similar 
which the dL-ehame is stopped — to Gonorrhoea. If this plan is adopt- 
On this subj-ct Mr. Mackenzie, ed the Bougie must be retained in 
(page 376) observes, "The only the urethra for several hours at the 
pointln which the treatment of this time, till the effect is produced." 
0.?pthal.mia differs from the former With regard to the treatment of 
is in the attempt, so much recom- those cases of Ophthalmia which are 
mended by some authors, to restore supposed to arise from the constitu- 
thesuppries(;d discharge of the ure- Hon being imbued with Gonorrhoea! 
thra. This i9 to be done by intro- disease— Scarcely any thing is re- 
ducing a bougie into the urethra, commended which differs from the 
covered with some of the purulent treatment of a similar state of Oph- 
dischargefrom the eye, or with G >- thalmia from cold or any common 
noirhoeal matter from another sub- cause. 
jfcet. Even the simple introduction The discharge from the urinary 



I fear I shall incur blame for having carried out this 
note to so great a length, but the consequences of delay 
or any misconception of the nature of this malady, es- 
pecially that of inoculating the eye with Gonorrhoea! 
matter, is so dreadful that I cannot possibly omit it. It 



passage may be present, or may 
not ; and, it is worthy of remark, 
that w i^n it has come on, not hav- 
ing been ubstrved when the Oph- 
thalmia b'gan, ii many cases, the 
occurrence of discharge from the 
urethra has made no difference in 
the symptoms of the Ophthalmia. 
Notwithstanding this, however, a 
celebrated writer upon Gonorrhoea 
(Swediaur) advises "the use of 
the Bougie for a couple of hours," 
with the intention of bringing on 
discharge. 

This kind of Ophthalmia too, is 
less severe than the former, or that 
wising from matter applied imme- 
diately in the eye ;— it is of a more 
chronic nature, and begins in the 
eyelids in the form of a little ulcer 
from which yellowish matter ex- 
udes : which in theformer kind, the 
whole surface of the globe of the 
eye and inner surface of the lids are 
affected with redness and swelling; 
the matter discharged also is pro- 
fuse and frequently acrid and ex- 
coriating to the outer lid and sur- 
rounding skin. 

Abemethy, in his surgical Lec- 
tures, calls it irritable Ophthalmia, 
and ascribes it to an irritable state 
of the constitution in which the 
bowels and digestive organs deeply 
participate. When this state of the 
constitution is brought on, either 
by the Gonorrhoea or the means 
adopted to cure it, he states that 
either this Ophthalmia or Rheuma- 
tism may occur ; or that they may 
both occur, alternating with each 
other, even alternating with the dis- 
ease of the urethra, and that the 



proper way of treating it, beside 
sooihii g applications to the eye, is 
to give five grains of blue pill every 
night and a dose of castor oil in the 
morning, keeping the patient on a 
strict spare diet. In support of this 
opinion hegiv s thefollowingcase. 
A gentleman who had been anx- 
iously endeavoring to get appointed 
commander of a frigate while in the 
country, at length received instruc- 
tion from the admiralty to take 
command of a frigate then lying at 
Falmouth. He lost no time in 
placing himself in the mail coach 
for London. Just before he left 
Edinburgh he had caught a Gonor- 
rhoea. In January his eyes became 
inflamed ; and when he reached 
London, he had a violent Ophthal- 
mia, with purulent discharge. He 
was in a dreadful state both of body 
and mind,— could not bear the light, 
and had great pain in his eyes. In 
this state he consulted M. Abeme- 
thy. He stated also that when the 
dischargefrom the urethra stopped, 
the eyes became bad, and when the 
eyes got well the Gonorrhoea re- 
turned. In this state Mr. Abeme- 
thy directed him to keep quite in a 
darkened room, to wash his eyes 
frequently in the course of the day 
with tepid poppy water, to take five 
grains of blue pill every night, and 
a dose. of castor oil next morning, 
and to live strictly low. " During 
the first six days he mended very 
slowly, and not considerable, but 
on the seventh day, when Mr. A, 
called, he found the patient sitting 
up in his room, the window unco- 
vered and his eys almost well. Mr 



need not, however, incommode the general reader, for 
being given in a note he can easily pass it by, while, 
should he be threatened with this formidable turn of the 
disease, he would derive important advantages from its 
perusal. But, indeed, if by the prompt and decisive 
means which are urged in every instance of this kind, I 
should be so happy as to save the sight but of one indi- 
vidual, I would willingly incur the blame of every other 

§2. 

Gonorrheal Rheumatism. 
With regard to this, I myself very much donbt its ex- 
istence ; for those however who may think otherwise, I 
have chosen to insert the following, also in the form of a 
Note, ( ) 



A. expressed his surprise and asked 
how this change had so suddenly 
happened, to which he answered, 
that he had had a number of very 
copious stools in the night, and that 
his complaints h .d left him. It 
seemed to be a sort of critical secre- 
tion from the liver and the whole of 
the alimentary canal, followed by an 
almost immediate removal of the 
irritable inflammation of the eye." 
Mr. Abernethy also takes occa- 
sion to warn persons against mis- 
taking this Ophthalmia arising from 
an irritable state of the constitution 
and digestive organs, for that fol- 
lowing inoculation, or t;e immedi- 
ate application of Gonorrhoeal mat- 
ter to the eye, for the means recom- 
mended for the first would add to 
the irritability and debility of the 
constitution, and increase the dis- 
order. His words are, that, " if 
the surgeon is frightened at this 



irritable Ophthalmiu, supposing it 
to b? one of the dr.-adful cases in 
which the eye is clapped, and pro- 
ceeds to bleed and purge the patient 
seveiely, he will only make the 
matter woise. Moderate bleeding," 
he s-ays, " may be useful, but the 
chief object is to fittend to the pa- 
tient's health. No means are so 
likely to be useful as setting the 
digestive organs to rights and send- 
ing the patients to the country." 

NOTE 

On the treatment of Rheumatism^ 
from tJie same supposed GonorrhceaJ, 
taint of the constitution, but little 
can be recommended in addition 
to what i6 approved in Rheuma- 
tism from other causes. The his- 
tory of a case of this kind will best 
convey what is meant by this dis- 
ease. 



M Major , aged 26, eontracted 

Gonorrhoea. In a fortnight he was 
seized with a swelling of the testi- 
cle. When this abated, pain and 
swelling of the right knee began; 
on travelling in an open carriage on 
the second day the other knee, foot, 
and joint of the great toe, swelled. 
The pain was excruciating. He 
then came under the care of Sir 
Henry Halford, (the king's physi- 
cian) but no treatment seemed to 
po3.^e? any power in removing the 
complaint. Now, in addition, his 
right eye was suddenly attacked by 
a very violent inflammation which 
threatened destruction to the organ. 
He then gave up medicine and went 
into the country for the restoration 
of his health, and after being there 
f<>r about three weeks, the Gonor- 
rhoea again increased without any 
abatement of the other symptoms. 
The joints so stiff and swollen he 
c uid h iidly crawl about. Warm 
bai hing and a residence by sea were 
recommended. From the former 
he experienced little apparent bene- 
fit, but alter a tedious convales- 
ence of two years, he found him- 
self able to join his regiment in 
Spain.— He recovered the use of 
hU limbs and had no return of his 
complaint, though exposed to ma- 
ny hardships in the campaign of 
1812, &c. &c. Two years after, he 
again contracted Gonorrhoea, a 
very violent one. In a fortnight the 
discharge began to abate and vio- 
lent inflammation attacked the 
great toe and foot. The disease 
then proceeded to the knees. As 
the violence of the inflammation 
of the knee abated, the left eye was 
attacked by violent Ophthalmiaand 



excited great alarm for its safety. 
It seemed to be deep-seated in the 
coats of the eye. The sight of the 
right eye was also impaired. At 
the end of two years more, his 
knee joint was stiff and much 
swollen, and the urinary passage 
was all the time subject to returns 
of Gonorrhceal discharge." 1 have 
given (lis case to show how possi- 
ble it ta for Rheumatism to occur, 
when a patient is affected with a 
Gonorrhoea, and how easy it is to 
suppose it is the effect of Gonor- 
rhoea, merely because it happened 
at such a time. But after all I see 
nothing in this case that differs 
from Rheumatism from common 
causes, and the present differs in no 
important point from others I have 
seen, which have been thought to 
arise from Gonorrhoea. Rheuma- 
tism is frequently a tedious com- 
plaint; its peculiarity is, shifting 
from place to place, and in this way 
it will sometimes assume the char- 
acter of inflammation of the eye, 
then of the joints, and will also 
sometimes alternate with disease 
of the urethra. Respecting the 
treatment of Gonorrhceal Rheuma- 
tism, if there be such, I am not 
aware of any particular in which it 
differs from the treatment of Rheu- 
matism from any common cause. 
As it is possible however that some 
connexion may exist between the 
inflammation of the urethra and in- 
flammation of the eye ; in cases of 
the latter kind, occuring when the 
patient has Gonorrhoea at the time, 
I think the recommendation of 
Swediaur, to employ the bougie, is 
a safe and justifiable remedy. 



CHAPTER V 

On Gonorrhoea in Females. 

There is no difference in this disorder in females but 
what arises from the difference in the organs which are 
the seat of it. Generally speaking, however, the in- 
flammation attending is more diffused ; in some cases it 
extends to the lower part of the belly, which makes it 
painful on pressure; also, the urinary passage being 
shorter, it is more apt to produce irritation in the blad- 
der than in males, so that there is a greater inclination 
to make water. There are no ulcers in this disease, al- 
though the discharge is sometimes so irritating as to ex- 
coriate or take off the skin. There is almost always a 
swollen state of the external parts. There are, however, 
some curious circumstances relating to this disorder in 
females which should be known, — the following are of 
this nature. 

Generally speaking, the disease is milder in women 
than in men. 

Also, a female may have a Gonorrhoea without her 
knowing it. This happens from the complaint being of 
a milder character, and from her not discriminating be- 
tween this disease and certain slighter forms of discharge 
which many females are subject to. It is most likely to 



occur in women of unrestrained intercourse, as such per- 
sons generally have the slightest forms of this disorder. 

The same female may give a Gonorrhoea to ont per- 
son and not to another. This arises from the habi> and 
character of the person himself. — If he has pursued h life 
of free and unbridled intercourse, he is much less liable 
to receive infection than a fresh and healthy person of 
a contrary character; the latter will frequently take a 
Gonorrhoea from a female who has only a slight, gleety 
discharge, whon the former would escape it. 

Again, a female may receive a Gonorrhoea from one 
person and give it to another without having it herself. 
This may appear strange, but it is a fact; — it happens in 
this way : A female has an interview with a person hav- 
ing a Gonorrhoea, and soon after sees a fresh and healthy 
person ; this latter comes in contact with the infectious 
matter before it has had time to engender the disease, 
and removes it ; the consequence is that he takes the Go- 
norrhoea and she escapes it ; it is an incident which often 
leads to very puzzling surmises. 

In the last place, — a female may always know, or at 
least have reason to suspect, she has an infectious dis- 
order, when she has lately had a Gonorrhoea and a dis- 
charge remains, greater, or in any way different, from 
what she was accustomed to before she had the Gonor- 
rhoea. 

• 6 



The treatment of this disease in the female differs in 
several important points from its treatment in the male ; 
— viz : there is much more occasion for the use of cool- 
ing drinks, especially those containing soda, — the use of 
the tepid bath, or warm fomentations is more necessary, — 
the appearance of her periodical illness complicates the 
case and demands great caution in the management of 
the remedies at that time. And again, with respect to the 
internal remedies, their influence over the disease is very 
much less ; though, any of those mentioned already may 
be taken, and sometimes are really used with advantage. 

Now, just as in the male, the first or painful and in- 
flammatory symptoms must be subdued before means are 
taken for stopping the discharge ; — this will be done by 
repeated purgative doses, and the free use of diluting drinks, 
together with low diet and rest. When there is much ex- 
ternal heat and inflammation, fomenting by cloths or flan- 
nels wrung out of hot popy-head tea is very useful. Four 
or six popy-heads should be bruised, and boiled in two 
quarts of water for a few minutes, and the liquor kept hot 
while used. 

Having then abated the pain and inflammation, and per- 
haps also taken some internal medicine for a few days, In- 
jections are at once commenced with. 

These Injections of course must be used by means of a 
female Syringe, which can be procured at any apothecary's 
store. 

With regard to the Syringe for Females in common usa, 
this is a very poor contrivance. Its great fault lies in its 



not enabling the patient to retain the injection in the 
passage ; it allows it to run away and escape immedi- 
ately, even before it can have reached the whole length 
of the passage, — thus the part of the inner surface that 
most needs the application is often entirely untouched. 
In order to have the full effect of an Injection, the Sy- 
ringe should hold enough to fill the passage, and when 
filled it should be retained there. My own Syringe, (a 
representation of which will be found on this page) is 
made to answer both these purposes, as many have happily 
experienced; for, after using the common Syringe for a 
length of time to no good purpose, they have succeeded 
with this contrivance to their fullest wishes. 

DR. RALPH'S IMPROVED FEMALE SYRINGE. 




With these remarks, I finish the subject af Gonorrhoea 
and Gleet in Females, and when it is considered that so 
long as any discharge, remaining after Gonorrhoea, exists, 
so long there is a possibility of spreading the disorder to a 
second person, a sufficient reason will be seen for laying so 
great a stress on curing Gleet at once, and doing so by In- 
jections, for it scarcely can be cured in any reasonable time 
without them. 

* Manufactured by Mr. Liese, 102 John Street. 



CHAPTER VI 

On Gleet. — Its Nature and cure. 

A Gleet is almost always the consequence of a badly 
managed Gonorrhoea. Instead of following up the cure 
of that disease by the means which have been so partic- 
ularly dwelt on, viz. Injections, the discharge is suffered 
to go on from month to month, and the effect of this is to 
entail a permament disordered condition of the parts affect- 
ed and which generally then goes under the name of Gleet, 
Weakness, &c. 

It is important to understand the nature of this malady 
as well as how to cure it, especially as a very serious 
error respecting its infectious nature, prevails with many. 
It is a very common thing to hear it said that a Gleet is 
not infectious ; but this is very wrong, and often leads to 
great trouble. Virtuous and unsuspecting women are 
unintentionally involved in this complaint in consequence. 
A person who is about to marry, for instance, may not 
have had Gonorrhoea for six or nine months, or longer ; 
but a slight discharge — so slight indeed that he has 
scarcely observed it — may have continued all this time. 
But he does not dream of its infectious nature until the 
saddest consequences show themselves. So, also, unfor- 
tunately, does a similar cause of unhappiness frequently 
occur in those that have been abroad or from their family 



for a length of time. Indeed, the consequences of this 
error are so very serious that it merits any pains and 
trouble to set the matter in its own true light, and per- 
haps I cannot do this better than by giving a case or two 
as related by Sir Astley Cooper. 

On this subject, then, Sir Astley observes, — " Gonor- 
rhoea, when neglected, sinks into a Gleet, and is known 
by the change of the color of the discharge, and the pain 
attending the inflammatory stage ceasing. In this state, 
is the discharge infectious or not ? I doubt myself 
whether a Gonorrhoea ever loses its power of causing 
infection as long as any discharge from the urethra re- 
mains, and I will give you my reasons for this opinion. 
A married gentleman went to Lisbon from this country, 
[England] and whilst at a distance from home, departed, 
as too many do, from the path "of virtue. The Portu- 
guese lady with whom he cohabited gave him the Clap. 
He returned to England, and, after the expiration of five 
months and three days after first observing the Gonor- 
rhoea, he called on me, and asked whether he might re- 
turn home with safety to his wife. He said he had a 
little discharge, and wished to know, if, after having it 
five months and three days, it were possible for it to be 
infectious. I replied — ( Certainly not ; you may go home, 
tnere is no danger of your giving it to your wife.' He 
T*«nt home, and unfortunately give his wife a severe 
O.iap. I attended both the parties afterwards, aud was 
fiJtreraely sorry for what I had done ; — but I thought, at 



the time I gave the advice, that a Gleet was not infec- 
tious. But I think differently now, — and believe that, 
after a continuance of several months, the discharge is 
infectious." 

Another instance. — " A gentleman from the north of 
England, who had been recently married, came to me and 
said that he had communicated a Gonorrhoea to his wife. 
Shocked at such an occurrence, I said, ' How could you 
think of acting in such a manner V ' Why, sir,' said he, 
' for fourteen months prior to my marriage, I had a Go- 
norrhoea; I made various attempts to get rid of it, and 
had a variety of advice about it, but a yellow discharge al- 
ways continued. I was told by every body that it was not 
infectious, and not until after such repeated assurances did 
I get married ; the consequence, however, is, that my wife 
has a severe pain in making water, and a copious dis- 
charge.' I visited her, and found her in this state ; she 
was some time under treatment before she quite recovered. 
From what I have seen, I do hold that a medical man is 
not warranted in saying that a discharge of a Gleetykind 
is not infectious." 

On these two cases thus faithfully related, then, every 
person may be able to form his own opinion on the infec- 
tious nature of a Gleet ; I think they are sufficient to make 
every reflecting conscientious person take care how he 
gives advice in such a case, particularly if his patient is a 
married man. Indeed, it is from this error, or from a 



total indifference as to its consequence, that we have so 
many cases of Gonorrhoea, — they are twenty to one com- 
pared with cases of Venereal. In fact the common wo- 
man of the town pay no attention to a Gleet. After the 
first or inflammatory symtoms of a Gonorrhoea have 
subsided, they mix with society as though nothing ailed 
them. In the patients of the Hospital called the w ' Lock," 
in London, for instance, nothing is more common than to 
see the Venereal and the Gonorrhoea in the same female; 
but it is the Venereal which brings them there. As to 
the Gonorrhoea, or Gleet, they will tell you they have had 
that a long time, and thought nothing of it, but having 
got the Venereal, in the form of chancres, they became 
alarmed, and anxious to be cured. So also, when the 
Venereal is cured, they seldom stop in the Hospital for 
the cure of the Gonorrhoea, or Gleet, but go out again 
promiscuously in the town and spread the Gonorrhoea in 
every quarter. 

I do not however, after all, say that every Gleet is in- 
fectious, but, they are so generally, and there is no mark 
whatever by which it can be said that this one is infec- 
tious and that one is not, — this can only be known by its 
consequences. How serious therefore to say to any one, 
especially to a married man, or one about to marry, that 
a Gleet is not infectious. But it is incumbent also to 
state, that there is a discharge from the urethra, in some 
measure resembling a Gleet, which is not infectious. A 
discharge of this harmless kind may proceed from two 



causes which may be easily understood. In the first place, 
it may proceed from a little abscess which occasionally 
forms in the urinary passage, and breaks; and the other 
is, a discharge proceeding from a Stricture. Now, the 
nature of these two causes of discharge must be under- 
stood, and then a suspicious Gleety disorder will be easily 
detected and distinguished from either of these. 

First, — With regard to the discharge from the little 
abscesses above mentioned, it should be known, that, in 
the whole length of the urinary passage are situated here 
and there, little sacks for the purpose of secreting a lu- 
bricating fluid; these are called lacuna. After a Gonor- 
rhoea, these little lacunae are sometimes affected with 
common inflammation, which forms into abscesses, and 
when these burst and their contents are discharged, the 
running ceases. Now-, the circumstance by which these 
abscesses may be distinguished from a Gleet, is this; — the 
discharge from these lacunae stops entirely for a week or 
tw r o, and then, when another breaks, it comes on acrain, 
suddenly, and again ceases as before ; but the discharge 
from an infectious Gleet never stops ;- — it may increase, 
from excesses or irrigularities of any kind ; and it may 
decrease, so as to become very trifling, — but it never ceases 
altogether. This, therefore, affords a good rule forjudging 
between Gleet and a discharge from these abscesses in 
the urinary passage 

And next, — With respect to the discharge arising from 



Stricture, this will be easily detected by ^considering the 
symptoms proper to Stricture. For the necessary instruc- 
tion on this subject, however the reader must be referred to 
Chapter ix, on Stricture. 

The Treatment and Cure of Gleet. 

A G-leet is often a very troublesome disease to manage. 
If there were no other reason for saying this, I might safely 
infer it from the numbers who have come to me with this 
complaint, having had it on them, more or less, for a length 
of time. These patients generally state that they have 
tried a great variety of means, and are quite disheartened. 
I cannot always learn particularly what these means have 
been, but two important things I do know ; firsts that what- 
ever they have been, they have always failed ; and next, 
whatever has been the state and condition of their case, the 
means I am now about to mention have always succeeded. 
I think it right to premise these remarks, because it may 
be thought the plan I recommend is very troublesome ; it 
may be so : but then, I would repeat, this plan succeeds 
when every other means fails, — and I am quite sure no bet- 
ter can be availed of. 

In the first- place, then, I would say, that if Gleet is 
of recent date — that is, if the originating disorder, the Go- 
norrhoea, were not taken above one or two months ago> the 
remedies recommended for the treatment of Gonorrhoea, in 
Chapter n, will generally prove perfectly successful. If, 
however it is an affair of several months, perhaps half a year, 
or a year, then different measures should be tajsen and which 



r will now describe. First, the Internal Remedies, as the 
Balsam of Copaiva and the Cubeb, — these, I do not hesitate 
to say, are worse than useless in settled Gleet ; — not only 
can they never cure it, but, holding it more or less in check 
whilst taken, they deceive the patient and induce him to 
fritter away valuable time, not to mention unnecessary phy- 
sic-taking and loss of money ; whilst in ninety -nine cases out 
of a hundred, the foundation for a permanent and serious de- 
rangement — Stricture, is being surely laid. 

In the use of Injections, however, properly employed, we 
may place the most complete confidence ; these sometimes 
in conjunction with another remedy presently to be men- 
tioned, form a plan of treatment which no Gleet can very 
long withstand. Any of the Injections employed for the 
Gonorrhoea may be used. 

But there is another very useful addition to Injections in 
the cure of Gleet : and this is the Bougie. I should advise 
it to be used in every case that had existed three months 
(from the originating Gonorrhoea) or more. You may then 
begin with the Bougie and Injections both at the same 
time ; or commence its use only when you have tried the 
other plan without proper success. 

Other remedies, and indeed several very different modes 
of treatment, are occasionally required in those old and ob- 
stinate cases of Gleet that we frequently meet with ; but 
they are mostly of a character demanding great judgment 
and experience in their application, and could not with pro- 
priety, or even with any utility, be entrusted to public or 
non -professional use. 



CHAPTER VII 

On certain diseases Resembling Gonorrhoea in some re- 
spects, and which are frequently mistaken for it ; but 
which, nevertheless, are totally distinct and different 
diseases. 

Nothing can be more valuable to those concerned than 
to know how to distinguish between real Venereal dis- 
eases and diseases which are not Venereal, but which re- 
semble it. Those into whose hands this little book may 
fall will be enabled to do this effectually, and will thus 
escape the advertising schemes of a set of people the 
most unprincipled and detestable that were ever suffered 
to deceive the public. These people, either from igno- 
rance or knavery, call every thing Venereal they may 
happen to see upon the sexual organs. Now, the struc- 
ture of these parts, in many respects, is the same as that 
of other parts of the body, and they are subject to the 
same diseases we meet with in other parts. It is a fact 
and one which I shall presently show most clearly, that 
many of the disorders these people call Venereal, have 
nothing at all to do with that disease. Nothing is so 
easy as to deceive an inexperienced person into such a 
belief. Knowing he has been once exposed, although it 
might be far too long ago to be the cause of his com- 
plaint, yet, if he happen to have any strange append** 



on these organs, he directly thinks it must be this disease. 
Indeed I am frequently troubled to convince them it is 
not so ; but Jet them go to any of the people I allude to, 
and they are sure to be confirmed in this belief. 

There is however another and a far more serious view 
to take of this deception : it is, its effects upon the mind. 
The money they extort on such a plea is nothing : nor is 
the fine and healthy constitution which they ruin half so 
great an evil as the anxiety and load they fix upon the 
mind — it breaks the spirits. In a single man, a false 
impression of such a kind may be of little consequence; 
and there are married couples, of a moral stamina so firm 
and unassailable, that, mutually confiding in their own 
integrity, no insinuation of this kind could possibly tell 
upon their happiness; but, on the other hand, there are 
others of a less confiding disposition, — those in whom 
symptoms so new and unaccountable, especially if ex- 
plained by insinuations of such a nature, would leave a 
deep impression, if not indeed, destroy the very basis of 
connubial confidence. And this is no imaginary case, 
nor yet a very rare one. Enjoying, as I do, much of the 
confidence of this city, and being known to have given 
much attention to this class and order of diseases, cases 
of this nature frequently occur to me, and, sometimes too, 
of great importance. This indeed will readily be ima- 
gined when the remarks I am now about to make upon 
the subject shall have been perused. 



The diseases which in some respects resemble Gonor- 
rhoea and are frequently Mistaken for it, but which, nev- 
ertheless, are totally distinct and different diseases, are 
chiefly four. These I will now proceed to notice, and 
will also show their proper treatment, which is always 
very* simple and successful. 

The first of these complaints occurs in men, and con- 
sist of, — 

The natural secretion of the part, accumulated beneath 
the fore-skin. 

When this occurs it becomes irritating and excoriates 
the inner surface of the fore-skin, as well as the head of 
the penis, giving rise to some uneasiness and swelling. 
At this time, if the fore-skin is pushed back, the parts 
beneath it look quite serious, — the discharge accompany- 
ing is offensive and considerable, — the parts swollen, — 
and the excoriated surface presents a red and quite angry 
appearance. Now, in this state, it is an easy matter to 
impose upon the mind the false idea of a Clap or Gonor- 
rhoea. Indeed as 1 have said before, it is sometimes dif- 
ficult to persuade a person it is otherwise. Yet, all this is 
a very innocent affair. To be convinced that this is not 
a Gonorrhoea, just look to page —observe the descrip- 
tion of that disease, and compare the two. There you 
will find that the discharge in Gonorrhoea issues from the 
orifice of the urinary passage, from which you may al- 
ways squeeze a little matter; but in this the discharge is 

• 7 



supplied from the surface of the fore-skin and head of the 
penis. This is quite enough to show it is not a Gonorrhoea 

And that it is not Venereal, you may likewise be as 
certain from the fact, that this — the Venereal — begins 
with one or two, seldom with more, distinct little ulcers, 
(see Chap, xin), which are inclined to become deep instead 
of broad, and which discharge but very little matter, 
whereas, in this, the discharge is copious, and there is no 
ulcer at all — it is rather an excoriation of the skin than an 
ulceration. Now it is a grievous thing for a man to be told 
that he has got a Gonorrhoea or a Venereal disease, and to 
be treated accordingly, under circumstances like these. 

The truth is, this case is nothing more than a little al- 
teration in the secretion of certain glands situated under 
the fore-skin, occurring frequently in those who neglect 
to wash these parts, particularly in hot weather; and its 
cure is easily accomplished, simply by washing often in 
the day w T ith simple Sugar of Lead Lotion, or brandy and 
water, or even plain cold water — taking at the same time, 
a dose or two of physic. 

If this should happen to be ineffectual, which is rare, 
a little bit of lint or soft rag, soaked in one of the Lotions 

NOTE 2.— White Vitriol 10 grains— Tincture 

I otions par top Arovf of M y rrh 2 diacb^s-TLaudaniim 1 

lotions for the Above drachm-water to fill a Uo-oun, e vial 

1. — Sugar of Lead 15 grains — Tine- Either one of these will ofteu be suf 

tme of Myrrh 2 drachms — water, to fill ficieut— the first is the milder. It is bet 

a two-ounce vial, a few drops of vine- ter, however, to obtain both, so as to 

garto be added to the water before the change the application every second oi 

Sugar of Lead. Another is, third day. To be used as directed above 



in Note , and applied two or three times a day, 
would certainly cure it. The application is best made 
by laying the bit of lint over the head of the penis, and 
then drawing the prepuce forward over it; in this way, 
it remains in contact with the inflamed surfaces. 

The next of these diseases is of more importance ; it is 
one which occurs in females, and often gives occasion to 
many painful and unfounded fears, for it approaches, in 
appearance, much nearer to Gonorrhoea. It consists of,— 

Symptoms resembling Gonorrhoea, communicated by 
Females in whom no appearance of disease can be detect- 
ed, or who have only those complaints which are consid- 
ered innocent and common. 

This is a disorder on which I am very anxious to be 
plain, and to be thoroughly understood. It occurs often 
in those who have a discharge resembling what is called 
the " Whites," or " Weakness." Now the Whites is a 
disorder to which many females, both single and married, 
are subject. The discharge of it varies in quantity and 
appearance ; it may be much or little ; clear, or opaque 
and milky ; thin and watery, or thick and adhesive. In 
one or other of these forms, however, varying from cir- 
cumstances, the Whites may continue for many years, 
proving nothing more than a secretion of what is nat- 
ural to these parts, but increased in quantity or altered as 
above described. The circumstances which originally 
cause, and which vary this disease, are many, — such as 



weakness of these organs, — too great fullness of their 
vessels, — having children fast, — or too great excitement 
of the parts, and others. But, although this disease, the 
Whites, may, and most frequently does remain for any 
length of time without producing any corresponding mal- 
ady in the other sex, yet, on the other hand, it may, and 
sometimes does become infectious, communicating the 
like disease to another person. 

Now the object of this chapter is to show that it does 
so, as it were, spontaneously, — that is to say, without in- 
tercourse, with other, or infectious persons. 

With respect to the fact itself, that disease resembling 
Gonorrhoea may occur in innocent women, spontaneously, 
which is so far contagious as to affect others, I would 
only observe, that there are but few Physicians of much 
practice who have not had cases which they would be 
puzzled to explain on any other principle. I will here 
give the outline of one or two as they have occurred to 
me. A gentleman came, for instance, with the following 
statement : — Sir, said he, I have some strange symptoms 
of disease about me ; and such, indeed, if it were not for 
ay confidence in another party, I really should suspect 
to be the symptoms of a Gonorrhoea, for I once contract- 
ed that disease and know something of its nature. Well, 
I said, what are the reasons which lead you to determine 
it is not a Gonorrhoea? The party I refer to is a lady 
whose word I could not question : besides, I have known 



her long, and am quite certain that no consideration in 
the world would allow her to expose me to the possibility 
of such a malady. And further still, having mentioned 
these circumstances to her, she denied it firmly, and is de- 
sirous that some one should see her — so perfectly uncon- 
scious is she of having any such disease. Now on this 
occasion I could detect no one single symptom of disease, 
and what is still more worthy of remark, I learned she 
was in the habit of being visited by another, and who 
also was perfectly free from every symptom of disease. 

But in my Note Book I have a still more curious case, 
and which I think is worth relating more particularly. 
It is this ; — A gentleman who had formerly been my pa- 
tient, consulted me on what we took to be a Gonorrhoea, 
and at the same time requested me to see the lady, whom 
he had known some time, and who assured him that she 
was perfectly free from any such disease. I did so, and 
found it exactly as he had stated, she had no one symp- 
tom — not even a Gleet. However, we treated his dis- 
ease as Gonorrhoea, and though the cure was tedious, he 
at length got well. But, sometime after, he renewed his 
visits to this lady, and was again attacked with a similar 
disease — symptoms which differed in no other respect 
from the Gonorrhoea, than in their mildness. After this, 
however, he kept away for a considerable length of time, 
and, although in this interval he had interviews with 
other females without disease, yet, in renewing once more 
his visits to this lady, he was again, for the third time, 
attacked with all the symptoms of a Gonorrhoea. 



I know it may be urged in all these cases, that they 
occurred in females of a certain character, and therefore 
they might have been old cases of Gonorrhoea, degenera- 
ted into infectious Gleet, — a disease which continues al- 
most indefinitely, — is not attended with pain, — and in 
which there is frequently but very slight discharge — not 
more, indeed, than many women (and females of this de- 
scription in particular) are subject to. But to this objec- 
tion I cannot hold, for two reasons : — first, because such 
cases sometimes occur in women who never had a Gono- 
rhcea ; and next, because, if they had been cases of Gon- 
orrhoea, or Gleet, they would be infectious to every one 
alike, or very generally so. Now and then, we know, a 
person may have an interview with a female who has 
a Gonorrhoea, or infectious Gleet, and may escape ; but 
this is an exception to a very general rule — it dose not 
often happen. Likewise, that one individual is more sus- 
ceptible of infection than another ; but this also is very 
limited — the rule being, and pretty uniform it is, that, in 
such cases, the disease communicates to all. Here then, 
while a common Gonorrhoea will affect all that come 
within its reach, or pretty generally so, this mild disorder, 
while it will affect some, will as uniformly suffer others 
to escape. It therefore affords a striking difference in its 
consequences, aud from this we may infer there is also a 
difference in its nature. 

My design in this section of this work, is to excul- 
pate innocent and virtuous women from injurious and un- 



deserved suspicion ; and this I apprehend to be an object 
of immense importance, for the consequences of such un- 
just suspicions might be painful and serious in the ex- 
treme. Even in the limits of my own experience I have 
met with lamentable instances of this kind; instances too 
in which I am morally certain there was not a particle of 
truth, and in which suspicion never would have gained 
possession of the mind, if the subject had been better un- 
derstood. 

With this view of importance, I therefore deem it pro- 
per to place this fact upon the best authority in medicine 
which can be adduced. Now I have already shown that 
symptoms resembling Gonorrhoea have been communi- 
cated by females in whom no symptoms of the disease 
existed, or were ever known to exist; but these females 
were not to be considered exemplary specimens of moral 
character. And further, I have stated them upon my 
own experience. I will now however, show that the 
same thing happens in females of the highest moral cha- 
racter, and will show it also on the very best medical 
authority. Here I might refer to the great John Hunter, 
to Abernethy, and a multitude of others; but in that 
highly esteemed and learned work — Goon's Study of 
Medicine, — there is a paragraph on this subject, so clear, 
that I cannot do better than transcribe it. In the fifth 
volume, page 8, after speaking of other diseases attended 
with mucous or purulent discharge, which are now and 
then contagious or infectious, — such as Dysentery, 



purulent Ophthalmia, and others, — he says, "In like 
manner, Leucorrhcea (which is the medical terra for the 
* Whites,' in females) as we have already observed, has 
sometimes seemed to be contagious ; for I have occasion- 
ally found a kind of Blennorrhea (Gonorrhoea or Clap) 
produced in man, accompanied with slight pain in the 
urethra, and some difficulty in making water, upon coha- 
bitation with women, who upon inspection, had no marks 
whatever of luodic Blennorrhea, or Clap, and in some 
instances, indeed, were wives and matrons of unimpeach- 
able character." This, at any rate, will satisfy the mind 
that such a thing is possible. 

But, neither has my experience on this point been con- 
fined to females of questionable character j I have seen 
the same happening between husband and wife, where 
there was no other ground of suspicion, and where a 
proper and scientific opinion, given at first, would have 
prevented much subsequent distress of mind to say the 
least. I have also had the satisfaction, in many such 
cases, of knowing that the information continued in this 
little volume has been the means, not only of removing 
unjust and cruel accusations, but of reconciling parties 
and even of preventing divorce. 

With respect to the question, — how can a harmless se- 
cretion be changed into an infectious one? this I cannot 
answer any more than I can tell why the discharge from 
Dysentery, or Ophthalmia, or common Catarrh, disorders 



which are generally harmless, should sometimes become 
contagious. The structure of the membrane which is 
the seat of the disease in all these maladies, is exactly the 
same as that which is the seat of the disorder in Gonor- 
rhoea. It may be, and no doubt often is, from neglect of 
necessary washing ; and to this the habit of irregular in- 
tercourse may give a greater tendency, for it is not to be 
denied that such instances are much more frequently ob- 
served in women of bad habits and inconstancy, than in 
virtuous persons ; but this by no means proves that these 
are cases of genuine Gonorrhsea, nor that they do not 

now and then occur in persons of a strictly virtuous cha- 
racter. 

With regard to the treatment of this complaint, it is 
axactly that of Gonorrhoea, for which see Chapter n on 
the treatment and cure of Gonorrhoea. 

It therefore appears that symptoms very much resem- 
bling Gonorrhoea, and which are infectious too, may be 
received by cohabiting with females who do not present 
the least appearance of that disease ; — that, although these 
are more frequently observed in females of lax morality 
and habits than others, they are also known to occur, oc- 
casionally, in women of exemplary character — even in 

NOTE instance, in Venereal. Two general 
principles chiefly regulate the treat- 
On this subject it may be remarked ment of them all ; the first directs what- 
tnat the treatment of Gonorrhoea is ever abates inflammatory symptoms, if 
very much the same as that of other any such exist ; the second, such re- 
diseases affecting similar membranes, medies as supercede specific actions by 
as in contagious Dysentery, Ophthal- setting up an action of their own— pre- 
mia, &c There is no specific remedy cisely as the Internal Remedies do in 
in any of them, such as Mercury, for the cure of Gonorrhoea. 



wives and matrons whose habits, age and religion, place 
them beyond uncharitable suspicion ; — and, that these 
complaints are cured by the treatment proper in the mild- 
est forms of Gonnorrhoea. 

A third disorder which resembles a Gonorrhoea, and 
which happens in men, is 

Stricture in the Urinary Passage. 

Stricture, upon excitement, will sometimes produce dis- 
charge exceedingly resembling Gonorrhoea, but without 
the usual degree of pain and inflammation attending that 
complaint. What a Stricture is, I will take great pains 
to describe in a future chapter. Here it is only needful 
to say, it is a contraction, or a diseased condition of some 
part or other of the urinary passage, generally the conse- 
quence of a badly treated Gonorrhoea, but which often 
continues for a time so free from pain or any inconveni- 
ence, that it is not suspected to exist, and is only brought 
to light by the occurrence of some sufficiently exciting 
cause. Now, the act of sexual intercourse is a sufficiently 
exciting cause, and hence the disorder now referred to is 
frequently observed to follow quickly after it. I have 
often been consulted by persons who have remarked that 
they are quite unfortunate, for they scarcely ever are ex- 
posed without contracting this disease; and, what to them 
is most remarkable, is, that others who have visited the 
same female have escaped, The fact is, that this is not 
a case of Gonorrhoea at all, but a Stricture ; and their 



friends have not these symptoms, because they have no 
Stricture. Of course, if such a person go to an advertis- 
ing knave, he will tell him immediately he has got a Go- 
norrhoea ; and further, the medicines he may give him 
may probably remove the symptoms, so that he will get 
the credit of curing a Gonorrhoea. But, in truth, he will 
no more have cured a Gonorrhoea than he will have cured 
a Cancer; for, with purgatives and a low diet, this dis- 
charge generally ceases in a little while. — It would there- 
fore seem exceedingly desirable to have some plain and 
positive rule to judge by in cases like the present, and 
fortunately, 1 have one to furnish. This rule is founded 
on the time when such symptoms first appear after con- 
nexion. The discharge I am now speaking of, that is, 
when it is from Stricture, first appears within twelve or 
four and twenty hours after such excitement, — a period 
shorter than is required in the quickest case of Gonorrhoea. 
Now, Gonorrhoea may be compared exactly to inocula- 
tion. There is always a process and a certain time re- 
quired, in order to produce the inoculated malady. It is 
true that some inoculations produce their proper symptoms 
sooner and more regularly than others; but the usual 
time peculiar to each is generally known, unless delayed 
or interrupted by some peculiar state of constitution, and is 
pretty regular. The usual period for the production of 
the symptoms of a Gonorrhoea is the third day after expo- 
sure to it. This however, is sometimes delayed for seve- 
ral days by the causes I have mentioned ; and, sometimes 
too, is a little quickened ; but, as to its appearing in twelve 



or four and twenty hours, that it never does, and never 
can do. This then I consider a valuable fact, — it forma 
the basis of an excellent rule in practice, the use of which 
may be seen by the following. To a person, for instance, 
consulting me on Gonorrhoea, I generally put this ques- 
tion first : — How long is it since you were exposed? Now 
if he should say, why, it is very recent — it was only last 
night, and I observed some symptoms of it in the morn- 
ing ; or, at any rate, if he should state that it is within 
twelve, or twenty-four hours after an exposure, I suspect 
at once it cannot be a Gonorrhoea. I then enquire if he 
ever had a Gonorrhoea before, and if he state that he has, 
my suspicions are confirmed, and I explain my reasons 
for them. This of course leads to an examination by the 
bougie, by which the real state is ascertained beyond the 
posibility of doubt, and he obtains a permanent and per- 
fect cure. But the value of this true and faithful expla- 
nation is greater than at first it may appear to be ; for it 
does not only undeceive and save an individual from pay- 
ing different persons for pretended cures of Gonorrhoea, 
but it also saves him from the consequences of occult or 
hidden Stricture — an evil which I deem by far more seri- 
ous and distressing than any to be found in the whole 
range of Venereal maladies. The object of this little 
section is therefore to show, that, among other causes ca- 
pable of giving rise to symptoms resembling Gonorrhoea, 
a hidden, dormant Stricture is one, that this is to be sus- 
pected whenever these symptoms appear within twelve 
or four and twenty hours, — but that this is only to be 



known for fact by passing the bougie. Its treatment con- 
sists in a little cooling physic, rest, and low diet ; if this 
is not sufficient, the usual treatment for Gonorrhoea will 
stop the discharge, but the only proper and permanent 
cure, is the cure of Stricture. 

The fourth and last of these disorders resembling Go- 
norrhoea is 

A discharge occuring in female children, and which 
frequently creates distressing apprehensions in the minds 
of parents. 

This consists in a discharge of matter from the genital 
organs, attended with some slight degree of inflammation 
and uneasiness. But this complaint in children does not 
originate in the parts themself, but in some distant 
parts, such as the gums, in teething ; or in the bowels, from 
foul and irritating accumulations there. This latter is no 
uncommon cause of the complaint. We know that irri- 
tation in the bowels in children is readily transmitted to 
distant parts, and is the cause of various maladies. If 
this irritation happen to fall upon the head, it produces 
a dropsy of the brain ; or, if in other parts, then other 
diseases take place, as sore eyes, or running sores from 
behind the ears, a swelling of the neck, or others ; so, if 
it happen to fall upon the mucous membrane of the fe- 
male organs, it then produces the disease we speak of. 
It is not, however, that this disease in itself is of so much 
consequence as the fear and misconceptions it may lead 

• 8 



to. Filled with apprehensions, for instance, a mother 
takes her little child to some physician, and if he happen 
to be unacquainted with its real nature, these apprehen- 
sions are confirmed. I have read, somewhere, of inno- 
cent persons being hanged from a misconception of the 
nature of this malady. With regard to the treatment of 
it, this of course is founded on the view here given of its 
nature ; remove the cause — that is, scarify the gums il 
they are inflamed, and cleanse the bowels with an active 
purge or two. Nothing more is wanted, except plentiful 
and frequent washing with cold water, perhaps sometimes 
with the addition of a little alum or sugar of lead. 



CHAPTER VIII. 

A few Remarks on that insidious disorder, Leucorrhcea, 
commonly termed " Female Weakness" or " Whites." 

(The following, though perhaps not properly belong- 
ing to this work, is nevertheless closely connected with 
the subject of the preceding chapter, and may prove use- 
ful here). 

This disorder consists, essentially, in a deranged condi- 
tion of the organs of generation, originating sometimes in 
a debility of the general system, and sometimes in the 
sexual organs alone. It may be induced by various 
causes, such as — any long continued illness — a damp, un- 
healthy residence — having children to fast — sexual ex- 
cesses — Gonorrhoea, &c , &c But, in delicate and ner- 
vous females, it frequently comes on without these inter- 
vening causes, and becomes as it were the settled habit 
of the constitution. It does not^ however, thus invade 
the constitution without disturbing one of its most impor- 
tant functions, for it leads eventually to Barrenness. There 
is also a most unfortunate coincidence to struggle with in 
those who are the subjects of this complaint, for it affects 
the constitution in such a way as to react upon, and in- 
crease the original disorder. If, for instance, it originate 
in weakness of the sexual organs, this, sooner or later, in- 
volves and debilitates the constitution, and thus keeps up 



and augments the original weakness ; or, if it begin in 
general nervous debility, this weakening discharge occur- 
ring, greatly augments that nervous debility. There is 
scarcely a complaint which the constitution suffers more 
under and has less power to overcome without the aid of 
suitable assistance. This may be clearly seen by reflect- 
ing on the influence which the uterine system is wont to 
exert upon the stomach and digestive organs. That train 
of distressing symptoms which so frequently occurs in a 
state of pregnancy, is a striking illustration of this fact. 
Numerous as these are, they all proceed from the effect the 
uterous (or womb) has upon the stomach, enfeebling and 
deranging its digestive functions. The very same effects 
are produced by this complaint, the " Whites," but with 
this difference, the derangement of the digestive organs 
from pregnancy is but for a limited duration, while that 
from weakness of the sexual organs is unlimited and per- 
petual. Again, by tracing the sad inroad this disorder 
makes upon the constitution, it will be further seen how 
justly it merits every care and anxiety to remove it ; for, 
beside the disappointment of a family, which it is fre- 
quently the cause of, there is nothing which more cer- 
tainly fades the youthful countenance, and prematnrely 
leads to the failings and infirmities of age. The first 
effect of this never-ceasing influence on the stomach is to 
weaken its digestive power, by which the blood becomes 
poor and watery. This is seen by that pale and sunken 
countenance, or bloated state of body, which always more 
or less attends it. Then follows an unequal circulation 



of the blood ; the strength of the body being not sulficient 
to maintain its equal distribution, some parts have too 
little and some too much; the feet are generally cold, 
marking too low a circulation in them, while the head is 
almost always overcharged, frequently leading the sufferer 
to suppose that bleeding would do good, than which, by 
the way, nothing would be more disastrous. Headache, 
however, arising from this cause, is one only of a long 
train of nervous symptoms, varying in degree and kind, 
but continuing to harrass and embitter life to its very latest 
moments. A more just and clear apprehension of so serious 
a disorder, therefore, than is generally entertained, can 
scarcely fail to secure a due and proper attention to the 
following account of its treatment and cure. In the first 
place, as this is a disorder which so greatly weakens the 
digestive organs, and through these the constitution, so the 
constitution scarcely can be strengthened, while the ori- 
ginal disease is suffered to remain ; it therefore becomes 
expedient to prescribe both for the local weakness of the 
sexual organs, and that of the constitution, at one and 
the same time, and in the neglect of this rule, is the rea- 
son why the treatment of this complaint so often fails, 
Now, this need of applying remedies to the diseased 
organs, at the same time that we act through the consti- 
tution generally, makes the use of a syringe absolutely 
necessary. But upon the kind of syringe used very much 
depends. The syringe in common use, as I have ob- 
served before, is not adapted to the purpose, and it is 
chiefly on this account that we so frequently hear of m- 



curable and tedious cases, even when the syringe is used. 
In the first place they do not hold fluid enough to fill the 
passage, and they have no means for retaining the inject- 
ed fluid for a due and proper time. These deficiencies 
lead to the contrivance of my " Female Syringe," which 
is found to answer most completely. 

DR. RALPH'S IMPROVED FEMALE SYRINGE.* 




A, — The Syringe as used for Injections for " Whites. 1 
B, — The piece used for this Injection, separately. 
C, — The piece for giving a Glyster to another person. 
D, — The piece for giving a Glyster to one's self. 



Leucorrhcea may occur in opposite states of the consti- 
tution, and the most important point to be ascertained in 
any given case, is, whether it is accompanied by strength 
or fulness of habit, or by weakness and exhaustion. 



* Manufactured by Mr. Liese, No. 102 John-street. 



CHAPTER IX. 

On Stricture of the Urinary Passage, — Its Nature— 
Symptoms — Consequences — Remedies — and Cure. 

§1. 

On the Nature and Causes of Stricture. 

The essential Nature of Stricture is Chronic Inflam- 
mation. 

A Stricture consists, at first, in a loss of that dilating 
or elastic property by which the urinary passage, which, 
while at rest, is in a collapsed state, becomes more or 
less unable to yield or open before the column of urine 
projected from the bladder : — 

The diseased condition exists, during the early or first 
stage of Stricture, only as a soft, swollen or puffy state 
of the delicate skin lining the passage, and perhaps also 
of the immediately subjacent tissue. Could a view of it 
be obtained at this time, a small portion of the passage, 
from a quarter to one inch in length, would be observed 
to be merely a little swollen and redder than the rest, 
and this would generally be situated at about five or six 
inches inwards, though occasionally near the external 
orifice, and more rarely still, at both places. The con- 
tact of an instrument with this spot, discovers it to be 



EXPLANATION OF PLATE V. 

Figure 1 Represents the appearance of Stricture in 
its first or Incipient Stage, consisting in a thickened or 
swollen state of the skin lining the urinary passage. 

Figure 2 Is the appearance of Stricture in its second 
or Dilatable Stage. Here, as is seen, the disease is just 
beginning to assume a more permanent form, a slight de- 
posit of diseased substance has commenced under the 
lining skin, and ridges or bands are formed. 

Figure 3 Shows the third, or Permanent Stage of 
Stricture. The deposit under the lining skin is considera- 
ble, pushing inward upon the passage, (where least re- 
sistance is offered), the diameter of which is greatly re- 
duced. 



PLATE V 




Figure I 




Figure 2. 




Figure 3. 



very tender or sensitive, the patient describing the .-ensa» 
tion to be as if a sore or raw surface were touched — 
which, however, is not the case. In this state a Stric- 
ture offers but little impediment (sometimes none) to the 
stream of urine, and no resistance to the passage of an in- 
strument* So true is this, that, except by a careful, ex- 
perienced and well-educated hand, it is easily overlooked 
or missed. 

This may be called the Incipient Stage of Stricture. 
(See plate in, figure 1). 

In the next or second stage of Stricture, an important 
change has taken place. That portion of the passage 
which was before in a merely tumefied condition, has 
now acquired a certain firmness, — it resembles a band 
encircling the passage, narrowing it at this point, and 
actually reducing its capacity. It now offers a decided 
impediment to the urine, and, if a moderate sized instru- 
ment is introduced, an evident resistance is met ; though 
with a gentle pressure, it yields, and the instrument 
pretty easily passes on. 

This has been aptly called the Dilatable Stage of 
Stricture. (See plate ur, figure 2). 

* This very often happens ; persons in truth merely because I hsd detected 
whom I have examined nnd declared a disease which had escaped their ex 
to hsve stricture, have afterwards heen ploration. I know this to have happen- 
to others, (in several instances which ed more than once, though some in- 
havn come to my knowledee, to Sur- stances I might not have known, but 
geon«, whose rank ami ability merit foi the kindness of a gentleman who 
the highest respect, and whose opinion not only stands first in the profession 
would hardly be called in question), in America, but whose name is placed 
who have said they had none , at the among the most illustrious of Europe, 
same time making u^e of remarks to- as 1 have myself heard from the lips of 
wards myself of a most ungenerous if Velpeau, Sedillot, and others 
net ungentlemn r.]*- nature . j^d wh 1- - 



In a still more advanced or third stage, the dilatable 

condition has appeared — the Stricture has become firm, 

or callous, as it is commonly called ; the contraction is 

unyielding, and an instrument meets an abrupt positive 

resistance, the calibre of the passage being frequently so 

diminished as hardly to allow the urine to pass at all, or 

even an instrument of the smallest possible size. 

This is the Callous or Permanent Stage of Stricture. 
(See plate in, figure 3). 

Now, it is not always possible to say that a Stricture 
is in exactly one or other of these stages, for the disease 
passes imperceptibly from one to the other — often so 
slowly that several years, sometimes many years, will 
elapse before a Stricture has passed from !he first to the 
second or from the second to the third. I not infre- 
quently meet with cases just verging upon the third stage, 
the commencement of which was undoubtedly established 
twenty, and even thirty years previously; others again 
will arrive to the same degree in a very few years. A 
Stricture, in a person of regular temperate habits, will 
sometimes remain ten or fifteen years without having 
fairly advanced to the second stage. 

On the nature of a Stricture also, it should further be 
observed, there is no natural cure for it. When a 
Stricture once begins, it is sure to go on increasing, either 
rapidly or slowly. Fortunately, however, we have the 
means of curing it by art, as will presently be described. 



Neither is it curable by medicine — all the medicine in the 
world, alone, would never cure a Stricture. 

The causes of Stricture may be numerous. It was 
said at the commencement of this Chapter, that the 
essential nature of a Stricture was chronic inflammation. 
It is now also said that, whatever is capable of pro- 
ducing or keeping up a long continued irritation or in- 
flammation in the urinary passage, may become a cause 
of Stricture, and that occasionally, though very rarely, 
Stricture seems to be spontaneous In a work of rather 
a domestic character, like the present, it would be at least 
useless to enter minutely into the causes of Stricture, yet 
is it well to state the fact, because, it is of the greatest 
importance to detect, early, its existence, and, when its 
symptoms are present, it should be examined into — 
whether the person has been exposed to its common 
causes or not. 

Now, the great and by very far the commonest cause 
of Stricture of the urinary passage is, badly cured Gonor- 
rhoea, and Gleet ; and the way in which it does so is 
this: — Gonorrhoea itself is essentially an inflammation, 
only of a specific kind. In Chapter I. it was stated that 
Gonorrhoea began at the orifice of the urinary passage, 
and that if not promptly and propeily cured, it reached 
the other end and there became fixed, obstinate, giving 
rise to great difficulty of cure and permanent Gleet, i. e., 
it passes from the acute to the chronic stage of inflamma- 



tion. But, it is well known that the ultimate tendency 
of inflammation of any kind is to thicken, to indurate the 
organ or tissue which may happen to be the seat of it — 
and the specific inflammation of Gonorrhoea has this ten- 
dency to a degree perhaps greater than any other — hence 
its proneness to give rise to this disease, Stricture. I 
think I should be safe in saying that ninty-five out of 
every hundred are from this cause. The next cause in 
frequency is Masturbation or Self -pollution* — this would 
perhaps account for four out of the remaining five; — the 
other one being from one of the rarer and peculiar causes 

§2. 

The Symptoms of Stricture. 

The symptoms which denote the existence of a Stricture 
should be considered with respect to those which attend 
its early, and those which attend its more established 
stage, and the more, as it is an unquestionable fact, that 
Stricture may exist in a mild and dormant form, and for 
a long time, and the sufferer be not in the least aware of 
it. On this account also it is desirable to be more parti- 
cular and plain in pointing out the early symptoms of a 
Stricture, not only because it is in the early stage that its 
cure is so easily accomplished, but because in this early 
stage the symptoms are vague and far from directing at- 

* The local disease produced by this however occupying much about the 

banefo.1 practice is sometimes actual same spot, have some symptoms in 

Stricture, but much mors commonly common. (See Chapter xi Maa- 

it differs considerable from it ; both turbetion^)* 



tention to the real seat of disease — the urinary passage — 
and without this knowledge and the proper plan it leads 
to, all the medicine in the world (and very much is often 
taken) would never cure it. 

Now, it was stated that a badly treated Gonorrhoea, or 
a Gleet, was by far the commonest cause of Stricture. 
When therefore a person comes to me with a Gonorrhoea 
that has continued an unusual length of time — several 
months, for instance — and especially if he has had a for- 
mer Gonorrhoea, I consider the length of time alone a suf- 
ficient reason to suspect the possibility of a Stricture, and 
it becomes my duty to assertain for fact, whether it be so 
or not ; and here it should be observed that the symptoms 
presently to be enumerated go no further than to afford a 
sufficient reason to suspect a Stricture. They do not 
prove that a Stricture really exists : the positive existence 
of a Stricture, especially in this early stage, can only be 
ascertained by examining the passage with the Bougie, 
which is a very easy and simple thing to do, as will pre- 
sently be seen. Nothing can better show the difference 
between the common advertising: knave and nostrum seller 
and the good and faithful Physician, than the difference 
of their conduct in the case of Stricture. The former will 
never trouble you with the sound of such a word, but 
will sell you colored drops, or pills, or some such thing, 
as long as you will take them, and then will leave you in 
a state of mental misery; while the latter will put his 
questions on the ground of the -possibility of Stricture, 



and if he should detect the least suspicious circumstance, 
he will not rest until he has ascertained the fact whether 
it be so or not. He will then explain the nature of a 
Stricture, and show the utter inutility of medicine in such 
a case; and afterwards conduct you to a safe and perfect 
cure. None but those who see it daily can form the 
least idea of the chagrin and misery that man escapes who 
falls into the hands of a good Physician in diseases of this 
nature. 

The symptoms about to be described are not compiled 
from authors, but from the very numerous cases that have 
come under my own observation, and which are minutely 
recorded in my Private Case-book. 1 have given them 
pretty nearly in the order of frequency and importance in 
which I have found them. 

Among the very early symptoms of a Stricture, there 
is one in which great confidence may be placed. It 
relates to the manner in which the last few drops of 
urine pass, which is by dribbling away. This is a symp- 
tom of great value in determining any doubtful case of 
Stricture, and deserves a word or two of explanation. — 
Now it happens in the very onset of a Stricture, and be- 
fore any possitive narrowness has occured, that a certain 
elastic power with which the passage is endowed, in or- 
der to expel the urine with a jerk, becomes weakened or 
is quite destroyed, so that it can no longer contract upon 
these last few drops, or ^ the consequence is they have to 



steal or dribble away after the act is over. Whenever I 
have reason to suspect a Stricture, therefore, I put this 
question, — Have you observed, when you have finished 
making water and buttoned up your clothes, whether a 
drop or two of urine passes afterwards, so as to wet the 
shirt a little ? and if they say they have, my suspicion is 
greatly confirmed. This is the most universal, as well as 
the very first of all the symptoms of a Stricture. Indeed 
a Stricture cannot exist without it. Not that I mean that 
this dribbling cannot proceed from any cause but Stricture, 
for it may proceed from weakness of the parts and other 
causes ; but a Stricture cannot exist without this drop or 
two of urine, and therefore whenever this is not observed 
you may be sure you have no Stricture. 

Another of the early symptoms of a Stricture is, a 
scattering of the stream of urine in making water, or a 
splitting of the stream, or a stream smaller than former- 
ly ; and if these or any one of these exist, my suspicion 
is increased. But even though he should have noticed 
none of these, still I am not certain he has no Stricture, 
for some of them, especially a diminished stream of urine 
may creep on so slowly as not to be observed ; and until 
the stream of urine becomes remarkably diminished a 
patient is very apt to overlook it, and say it flows as usual. 
I have had persons tell me this, when, on examining the 
passage, I found a well marked Stricture, and then, re- 
flecting on their former way of making water, they have 
been convinced their stream was not so large as formerly. 



A certain hesitation in commencing to urinate, although 
the stream flows fully and easily enough when once 
started, may be added. It is very common to have this 
hesitating or waiting longer than natural, then a full 
stream, then again the dribbling away afterwards. 

Another circumstance attending the early as well as 
the later stages of a Stricture, and which in some degree 
or other is almost always present, is its effect upon the 
Mind and Spirits, to depress them. — In some individuals 
this effect proceeds so far as to make them hypochondriac, 
and in almost every one there is some degree or other of 
it, so that he is not so energetic in, nor so capable of 
business as formerly.' By this depression I do not mean 
that lowness and dejection of the mind produced by 
gloomy apprehensions, or the deceitful tricks of adver- 
tising people; these are, indeed, enough to affect the 
spirits, but the depression I refer to arises from a very 
different cause, and is often present when there is scarcely 
any other mark of Stricture. This effect of Stricture on 
the spirits, arises from the intimate connexion which sub- 
sists between the sexual organs and the mind. Every 
body is aware of the effect of a single thought of a certain 
nature upon these organs. Now it happens throughout 
the body that whenever one part has the power to affect 
another, the later also has the power to affect the former. 
For instance, if a sexual thought, through the medium 
of the nervous system, has the power of influencing the 
genital organs, in like manner a diseased condition of 



the genital organs has the power to influence the mind, 
and it is on this striking reciprocity of sympathies that 
Stricture in the urinary passage is so wont to depress the 
spirits. 

Connected with this symptom, is also a loss of memory. 
Patients frequently complain to me that, since their 
Slricture commenced they have noticed more or less de- 
fect in the memory, especially of names ; and it is often 
surprising to see the rapid improvement of this faculty 
that attends the relief of the Stricture. Sometimes there 
is a diminution of memory but without the depression of 
spirits — often both are together. 

A Diminution of the Sexual Inclination^ or of the 
Erectile Power. This is a symptom which in very many 
cases make its appearance early. It is in realty the 
commencement of Impotence; and though in the early 
stage of Stricture it is generally noticed in but a slight 
degree, still it is occasionally at this period a prominent 
source of complaint A curious case of this kind is at 

present under my care. Mr. had a Gonorrhoea 

about four years and a half ago — it was four months be- 
fore the discharge was stopped, and then a slight Gleet, 
varying in quantity, but always very little, was left. He 
discovered the existence of Stricture about two years af- 
terward, and some months later being with a female he 
had long known, he suddenly, and in one night, lost his 
erectile power — become impotent, and has so remained 



to the present time. So sudden an attack is certainly 
rare, but it does happen occasionally ; I have seen seve- 
ral such. It is very common however to have it creep 

on slowly. 

These then are the circumstances which denote the 
early stage of Stricture; and when it is considered that 
they are circumstances which do not in themselves natu- 
rally suggest the idea of Stricture, and also that Stricture 
exists in those who are not at all aware of it, they would 
seem to be exceedingly worthy of attention. To reca- 
pitulate therefore it may be stated that, — Stricture is a 
disease which often exists in those who are not in the 
least aware of it, but there are certain circumstances 
which should always lead to its suspicion; these circum- 
stances are — A slight alteration in the manner of urina- 
ting, a drop or two of urine which steals away after the 
act is over, so as to wet the shirt a little — Depression of 
Spirits or of wonted energy of mind, and failing of 
memory, or both — Diminution of the Natural Sexual In- 
clination or of the Erectile power. 

There are other symptoms which often attend the early 
or about the first and second stages of Stricture, but 
which are less constant, that is, they will be found in 
some cases while in others they will not be complained 
of at all. 

Gleet. In many cases of Stricture there is a discharge 
from the urinary passage, but this does not happen in 



every case This discharge may be only a little more of 
that mucous which is natural to the part, or it may be real 
pus or matter. Whatever it is, however, it varies from 
many circumstances of excitement, and is generally very 
easily brought on or increased ; a glass or two of spirits. 
unusual exercise, sexual intercourse, will produce it, and 
it more or less easily subsides again. When the discharge 
is considerable, it is often taken for a Gonorrhoea, espe 
cially as it may be attended with burning pain in ma 
king water, and chordee, all of which is very apt to fol- 
low the excitement of sexual intercourse. This kind oi 
Gleet may attend all stages of Stricture. (See Chapter 

VII 

Weakness and Pain in the Back, is very frequent, and 
may be present in any stage. It sometimes feels as if 
the sensation commenced in the groin and running round 
the hips reached the small of the back Not uncommon- 
ly this pain is first noticed after lifting some heavy 
w T eight, and is then taken for " a strain ;" the different 
plasters, &c, that are applied, seldom give any relief, 
and many, still unconscious of the existence of Stricture, 
at last suppose themself to be affected with Gravel or 
Kidney-disease. I am often applied to for such supposed 
maladies, the majority proving to be cases of Stricture, 
and rapidly relieved by an appropriate treatment, to the 
great astonishment of the patient. 

Pain running dovm the thighs and legs, and sometimes 



most complained of in the soles of the feet, should be 
added here. 

An Itching or Tickling in the Urinary passage, or 
when urinating, is another rather common symptom. 

A frequent desire to Urinate, with more or less inability 
to hold the urine when the desire comes on, and often 
obliging the person to rise several times in the night. 
This, when it exists to any great degree, is a very annoy- 
ing symptom, and often one of the most obstinate and 
difficult to overcome ; and unlike most of the others, which 
spontaneously disappear along with the cure of the Stric- 
ture, often requires separate treatment. 

Another effect of Stricture, and one very similar in its 
nature to the depression of Spirit and of Memory, is that 
which it produces on the Stomach and Organs of Diges- 
tion, for the same medium which connects the mind with 
the genital organs, connects it also with the functions of 
the stomach. Nothing is more common than to see a 
train of nervous or dyspeptic symptoms which have re- 
sisted every means of cure, most happily and unexpect- 
edly disappear on proceeding in the cure of Stricture. — 
These two circumstances therefore — depression of spirits 
and nervous dyspepsia — may very properly be placed 
among the symptoms which attend the early stage of 
Stricture. They are not of course to be depended on 
alone, apart from other symr>toms. for it is well known 



10 



that they may arise from other causes ; but in cases 
where there is only a mere suspicion of Stricture, it would 
be well to consider if either of these where present, for, if 
so, it would greatly strengthen that suspicion. 

A Shrinking or Dwindling of the Penis, often with 
diminished erectile power. It is not easy to account for 
this, but of the fact itself I am well assured. It is some- 
times, though more rarely, quite an early symptom. I 
have had patients apply to me whose only object of com- 
plaint was this, having observed no other until led to 
think more particularly on the subject, and not dreaming 
of a Stricture. On removal of the Stricture, it resumes 
its wonted size and firmness. 

But, so far I have spoken of Stricture only in its 
early stage — at the time when its symptoms are often so 
few and give so little inconvenience as to allow its exist- 
ence to be overlooked ; in its advanced stage however, 
the symptoms are very numerous, and some of them most 
deeply interesting. The interesting nature of these 
symptoms arises from their remoteness from the seat of 
the disease itself, so that when they present themselves, 
they are never once suspected to arise from Stricture, 
and, consequently, never get relieved. Many serious 
diseases, which, from their having proved unyielding 
under a variety of modes of treatment, have been thought 
incurable, have been so because they have arisen from 
Stricture, which was never thought of. 






Week or sore Eyes. — A few months ago a captain of 
a merchant vessel from Havana came to me with a re- 
cent Gonorrhoea ; but who, in a little while, I perceived 
had got a Stricture also from a former Gonorrhoea. Of 
course I soon attacked the Stricture, but, as the cure of 
this proceeded he told me, with the greatest pleasure and 
surprise, that his eyes were better. Now this was the 
first time he had spoken of his eyes, though I had noticed 
they were very red and irritable. He then told me that 
his eyes had been bad for years, — that he almost always 
wore a shade, and that they were frequently so bad at sea 
that he could not open them at all in common day-light. 
This, therefore, was a case of Ophthalmia from a Stric- 
ture which had given him so little inconvenience, until 
a fresh attack of Gonorrhoea occured, that it was 
never once suspected. By the time the Stricture was 
cured the eyes got entirely well, and I believe will never 
trouble him again. But this is nothing new in the treat- 
ment of Stricture ; nothing is so common as to see com- 
plaints which had resisted every former mode of cure, 
particularly diseases of a dyspeptic nature, entirely disap- 
pear on the cure of Stricture. The symptoms denoting 
confirmed and long-standing cases, therefore, indeed every 
thing relating to this subject, is deeply interesting. Sim- 
ilar cases have frequently occured to me. 

Sores about the head of the penis and foreskin, much 
resembling Venereal and frequently mistaken for it, 
(see Chan, xx ), are also among the symptoms of a Stric- 



ture. The late Mr. Abernethy, in his work on Syphilis, 
has admirable shown this fact. To w T hat he has stated I 
can also add my testimony, for instances have occurred to 
me in which these sores have proved unyielding under 
many surgeons and different modes of treatment, but 
which have got well immediately on treating them ac- 
cordingly. 

Sores and other affections of the throat are sometimes 
symptoms of Stricture ; they occur on the same principle, 
viz : the sympathy existing between the organs of gene- 
ration and the throat, — so that disorder in one will pro- 
duce disorder in the other. Many curious facts might be 
stated on this subject, but, as I observed, being rather 
curious than of practical importance, I will state them in 
a Note. 

Hypochondria. — There are many remote diseases which 
arise from Stricture, in consequence of the sympathies 
which exist between the sexual organs, and distant 
parts of the body. In other words, a Stricture in the urin- 

NOTE upon the lips and chin. — Young wo 
men who have beards are generally 

The sympathies between the organs less prolific than those who have none- 

of generation and the throat in both Bingham mentions a case which camp 

sexes are very striking. Not only is the under his own knowledge of a young 

beard upon the chin prevented if the lady who had a beard, but lost it aftei 

testicles are removed before the age of her marriage. All this shows the m- 

puberty, but also the developement of timate connection which exists be- 

the throat is hindered, so that the voice tween these distant organs and ac- 

fails to attain the deep and tenor tone counts for many morbid actions oc- 

ofmen. It is a curious fact, that when curing in the threat simply from 

the corresponding organ of the female spmpathizing with a Stricture. Se* 

U removed, (as the ovaria in spaded Chap, xi in which will be found some 

animals), the voice becomes deep and interesting and important remarks oc 

rough in women, and hair shoots out thi« subject. 



ary passage is capable of disturbing the stomach, and 
through this medium, of inducing other and remote com- 
plaints, all of which therefore are correctly placed among 
the symptoms of Stricture. These complaints are chiefly 
of a nervous character, as head-ache, low spirits, diminu- 
tion of wonted clearness of mind, and other hypochon- 
driacal feelings ; and so evidently are these the effect of 
Stricture, that they cease as its cure proceeds, while they 
resist every measure short of this. 

The hypochondriacal state of mind resulting from Stric- 
ture of the urinary passage sometimes exists to such a de- 
gree as to become truly distressing and serious. There is 
no doubt in my mind that many suicides, happening when 
the circumstances and other relations of the individual 
cannot in any way account for the act, are in reality the 
consequence of the severe mental depression which some- 
times attends Stricture. In these cases I believe the suf- 
ferer is generally ignorant of the existence of such a cause 
of his misery — a knowledge of it would have saved him, 
for with the knowledge would have come at least a hope 
of relief, if not of cure : but unfortunately again the false 
delicacy existing on the subject of diseases of the generative 
organs tends to operate very unfavorably on some minds. 
A gentleman whom I cured of Stricture a few years ago, 
and who was at the time a professor at West Point, as- 
sured me that he had twice been down to the water at 
night to drown himself, but happily returned without 
doing so, from irresolution, — he had a very bad Stricture 

• 10 



Another patient, young, and having a Stricture scarcely 
advanced to the second stage, carried arsenic in his pocket 
for some time with the view of destroying himself; — he 
was in an excellent and prospering husiness. Many have 
declared to me that their failure in business had been 
attributable to the effect of Stricture on their mind and 
energy. I might give a long list of the like. 

Another symptom I will mention is a hardness and dis- 
eased condition of the testicle from Stricture. This in- 
deed may arise from other things than Stricture, but when 
it thus arises, and this I often find to be the case, it never 
can be cured but by the removal of the Stricture. 

As 1 have said before, a contracted stream of urine, more 
or less, always attends a Stricture, but this creeps on so 
gradually, and with so little disturbance, that it often 
quite escapes the notice of the patient. But, as the nar- 
rowness of the Strictured part increases, that is, as the 
Stricture grows worse, this alteration or contraction 
draws attention, for it becomes very small, or divides into 
two, or sprinkles on the ground, and in very bad cases 
it passes only drop by drop, and that not without some 
straining. Sometimes it is necessary to make a great ef- 
fort at the beginning, and afterwards it will flow in a 
tolerable stream; at other times the desire comes on so 
quickly that you cannot retain the urine for a moment. 
This is when the bladder participates in the disease. 



The bladder is always more or less disposed to this par- 
ticipation, so that many patients are obliged to get up 
in the night to urinate, and this generally increases with 
the Stricture. 

Mr. Bingham, of London, a very sensible writer, has 
exceedingly well enumerated the various sensations and 
other symptoms which may occur in Stricture. I shall 
transcribe from his work the most important, leaving out 
however all technical words. Nothing, correctly detail- 
ed, can be uninteresting to one afflicted with Stricture. 

Mr. Bingham observes — " Various kinds of sensations 
also, are produced in different degrees, by Stricture in 
the urinary passage; as an itching of the penis or the 
parts about, and a fluttering or pulsating sensation in. 
some parts of the passage; numness of the thighs is 
another symptom; as are also a smarting or burning 
pain in the head of the penis, and darting pains shooting 
to and fro from the fundament to this part, or up to the 
back and loins; pain in the hip, down the thighs and on 
the inside of the knees, frequently occurs from Stricture 
in the urinary passage, and pain has also been known in 
the sole of the foot from the same cause." 

Again he observes — " Sexual intercourse is apt to ag- 
gravate the symptoms of Stricture whatever they are. — 
Sometimes this act is attended with pain and inability to- 



emit the seminal fluid ; at other times only part of it 
passes, and the remainder steals away when the erection 
has ceased. Retention of urine has many times been 
brought on by sexual connexion in patients troubled 
with Stricture." 

" The penis is variously affected by Stricture. Some- 
times the erections are excessively frequent and trouble- 
some, and these may or may not be accompanied with 
seminal emissions, during sleep ; at other times the erec- 
tions are weak and inefficient, and, occasionally, alto- 
gether wanting." 

" Sometimes swelling of one or more of the glands in 
the groin, and enlargement of the testicle, indicates the 
existence of Stricture in the urinary passage : and, ano- 
ther symptom is, hardness to be felt externally in the sit- 
uation of the Stricture. Inflammation and a gathering 
in that part between the anus and the testicles, are also 
symptoms of the disease." 

" It has been stated upon high authority, that strictured 
patients cannot comfortably cross their legs ; but when- 
ever I have had an opportunity to notice this, there has 
been, besides the Stricture, disease of the prostate gland," 
(a hardish body situated at the entrance of the bladder, 
just where the urinary passage begins, and which is ex- 
ceedingly liable to enlargement in elderly people), " or 
inflammation about this part." 



§3. 
The Consequences of Stricture. 

The consequences of a Stricture are truly lamentable, 
not only being distressing to endure, but some of them 
totally incurable — admitting only of relief. I speak how- 
ever now of old bad cases, such as have been suffered to 
run on for years, or badly treated. Besides those sym- 
pathetic disorders which were noticed in speaking of 
the symptoms of a Stricture, there are consequences 
which are more immediately connected with it, and these 
I next propose to state. 

One of the first of its consequences is, the effect which 
straining has upon the bladder. The more resistance the 
Stricture offers to the flow of urine, of course the more 
exertion must the bladder make. This leads to a thick- 
ening of its coats (see plate ), and to other conditions of 
it which make it irritable and capable of retaining but a 
very little urine, so that the calls are frequent and press- 
ing, disturbing sleep and rest. From the same cause 
also the kidneys are very apt to be diseased. 

The next effect of so much straining is produced upon 
the passage itself just behind the strictured part. The 
force of the urine, as may easily be imagined, dilates 
the canal and forms a pouch or bag, (see plate 4), in 



which a portion of the urine lodges. But this, whicn al- 
ways happen, more or less, may lead to lamentable con- 
sequences. In the first place it may render the passing 
of the Bougie impossible; for when the pouch is large, 
the orifice leading out of it may not correspond exactly 
with that leading into it, so that the Bougie may easily 
pass in, but not pass out or through it. And in the next, 
the urine lodging here, is very apt to irritate and produce 
disease. Disease arising from this cause is of the most 
distressing and permanent kind ; matter forms in the sub- 
jacent structures and makes its way out, both by opening 
into the passage, and also by opening externally, ulcera- 
ting through the parts between the thighs. But the 
worst is, the passage it thus makes will not heal. It is 
difficult and sometimes quite impossible to prevent the 
urine passing through it. This is what is called a sinus, 
ox fistula in perinceo, (plate 4). I scarcely know a more 
disagreeable and inconvenient thing than a sinus in these 
parts, — the person is obliged to squat down in making 
water to do it comfortably. But, to form a true and 
clear conception of this malady, (and every one should 
do so, in order to avoid that class of people who produce 
it), it is necessary to see it in a plate, and with this view 
I have selected the one on the following page, from one 
of the best and latest authors on the subject, and from 
this it will be correctly judged how serious a thing it is 
to neglect a Stricture. Indeed, so true is this that a very 
eminent writer on this subject, Sir Everard Home, Sur- 



geon to the late King of England, in his third volume, 
has a chapter upon — Diseases of an incurable nature, 
the consequences of a long continued Stricture, before the 
proper means of removing it had been adopted. 

Among the consequences of Stricture also may be no- 
ticed, a shrinking and dwindling of the penis, with but 
little erectile power, but to a much greater and more se- 
rious extent than that mentioned before ; as in the slighter 
degree, however, the removal of the Stricture restores its 
natural state. 

A similar state of wasting of the testicles is also a con- 
sequence of Stricture. 

Impotence is another, and the last to notice. This 
may occur with or without the loss of sexual inclination. 
There are two ways in which a Stricture may be the 
cause of impotence-^-the one mechanical, the other func- 
tional. In the first, the function of the testicles is per- 
formed, but the fluid is impeded in its passage, or its im- 
petus so broken as to fail in accomplishing its destined 
purpose. In the second, the function of the testes seems 
to be disordered, so as to have lost its essential and vivi- 
fying principle. This is no difficult thing to imagine, 
when the nervous structure of these organs, and the ex- 
quisite sympathies depending on them, are considered. — 
And, further, this opinion is supported by the fact of so 
many strictured persons having no children. 



EXPLANATION ON PLATE VI. 

A, — A section of a bone. 

B, — A part of the penis. 

C, — The scrotum. 

D, — The testicle. 

E, — The urinary passage. 

F, — The bladder, much thickened in consequence of 
straining to make water. 

G, — The lower intestine. 

H, — The Strictured part of the urinary passage, the 
source of all the disorders of the other parts. 

I, — The ulceration behind the Stricture, from whence 
the urine has been discharged into .the sinuses or ulcera- 
ted passages running between the thighs and scrotum. 

K, — The urinary passage and neck of the bladder dila- 
ted, (forming a pouch) behind the Stricture. 

L, L, L, — The several openings through which the j 
matter and urine have continually flowed. 



PLATE VI. 




11 



These then are the consequences of Stricture, and when 
to them is added those sympathetic aitections which were 
arranged among its symptoms, together with the expense, 
and suffering, and keen reflection which is naturally con- 
nected with this disorder, it will be seen with what pro- 
priety it is urged on every one to be careful as to whose 
care he intrusts the cure of Gonorrhoea. All these 
consequences are perfectly unnecessary, and would be 
avoided if the same good sense were exercised in select- 
ing a proper person in this complaint as w r ould be done 
in any other. 

But Stricture is a curable disease, and very especially 
so in its first stage, and fortunately again, with many, this 
first stage continues for a length of time. It is fortunate 
also that its principle of cure is simple, easy and certain. 
It requires only to be acquainted with this, as given in 
the fifth section of this Chapter, and at the same time to 
be furnished with these simple means, in order to enable 
any one to undertake the cure himself with perfect satis- 
faction and success. 

The Remedies for Stricture. 

First, let it be remenbered, no medicine in the world 
will ever cure a Stricture. 

Medicine certainly is given, but it is with the view of 
removing any other complaint or impediment to the cure. 






It has been stated and explained that Stricture of the uri- 
nary passage is capable of materially disturbing the func- 
tions of the stomach ; a knowledge of this fact is of great 
importance in the treatment of Strictures, for, as a Stric- 
ture in the urinary passage has so much influence on the 
stomach, in like manner the Stomach influences the Stric- 
ture. Now, we can at all times prescribe for these dis- 
turbances, and hence the cure of Stricture is so much 
expedited by attending to the stomach throughout its 
treatment. My own practice verifies this statement daily. 
Medicine, therefore, if given, is only for the purpose of 
restoring or improving the general health, — not for the 
cure of the Stricture. 

The Bougie is that without which you cannot cure the 
disease. Nor is this at all to be regretted, for it is a sim- 
ple, safe, easy and certain way of curing it. 

Bougies are made of different materials; two kinds 
only however, are fit for use : these are the Wax and the 
Elastic* The Wax Bougies are not so smooth and 
pleasant to use as the Elastic, but they have the advan- 
tage, sometimes very useful when there is any par- 
ticular difficulty, of retaining the shape into which they 



* Bougies are also made of metals and finding all can be affected by the wax 

different kinds of compositions — even and the elastic Bougie far better, easi- 

of Iron, of Catgut, prepared Ivory, er and safer, and always with less in- 

&c, &c. Some are more fanciful than convenience and pain to the patient, 

useful, and as to metal Bougies of all All the modern continental authors on 

kinds, I do not hesitate to condemn Stricture, and there are many, are of 

them altogether; for private use they this opinion. I have not myself, with 

are highly improper, and every modern a very extensive practice in this dis- 

Surgeon who has much experience in ease, used a metal Bougie for severa. 

this department soon renounces them, years. 



may be bent; — they are not very fit for private use. The 
Elastic Bougies are generally to be preferred, they are 
more polished and easier to the patient, and, if always 
curved one way, they retain the shape sufficiently well; 
they are also, when warm, so pliable as easily to accom- 
modate themselves to the natural curve of the passage. 

Bougies, both Wax and Elastic, are either Cylindrical 
or Conic, as here represented. 

A Cylindrical Bougie. 



A Conic Bougie. 

The Cylindrical Bougies are fitter for Stricture in its 
earlier stages, — the Conic for more advanced cases, 
\ ,ere absolute contraction or narrowness has commenc- 
ed; though either may be employed in either case. Of 
course in the third stage (see plate in, figure 3) Conic 
Bougies are very preferable. 

Bougies are made straight, but when they are to be 
used, are bent into a certain form. This is easily done 
by warming a little either before the fire or in the hand. 
The following represents the curve a Bougieshould have. 
It is of the greatest consequence to give it this shape. 

The proper curve or shape to be given to a Bougie for using. 



J 



The manner of using or introducing a Bougie. 

(See Plate VII). 

We will suppose it the first time of using a bougie, — 
the object being to ascertain for fact whether there really 
be a Stricture or not. You select an Elastic Bougie of 
medium size, and holding it in the hand or before the fire, 
you warm it a little, so as to give it the curve just repre- 
sented without cracking its polished surface. In giving 
it the proper curve you will find from its elastic property 
that it will become straight again. Do not mind this, 
for, having given it the curve while warm, it will more 
easily assume it when it meets with the corresponding 
curve of the passage ; (it is an excellent plan to put it 
away while warm in such a position as to keep this 
curved form till used again). You next rub on it a 
little sweet oil or lard, and then proceed to introduce it. 
Take the penis, at its sides, behind the head, between 
the thumb and finger of the left hand, and stretch it for- 
ward a little, rather pointing upwards, but very little. 
Then with the Bougie between the thumb and fingers of 
the right hand, and with the curved end pointing upward, 
introduce it at the orifice, and pass it steadily on with a 
gentle and continued pressure till it reaches the bladder, 
which can be easily told by a peculiar sensation and the 
ceasing of any feeling of resistance. Take particular care 
to keep the Bougie in the same position as at first, that 
is, with its point directed upward, for if the point were to 
turn to the side, or especially downward, it would not 

• u 



EXPLANATION OF PLATE VIL 

Showing the manner of introducing a Bougie into the 
Bladder. 

A, — The Bladder, which, it will be seen, is situated 
higher up into the body than the urinary passage. 

B, — The internal orifice of the urinary passage turning 
upward to reach the bladder. 

C C C, — The lower C represents the external orifice 
of the passage, in its common or natural position, and in 
this state the urinary passage is seen to have a double 
curve, like the letter x/i reversed. The upper C shows 
the passage, the penis being held out and upward from 
the body. The middle C supposes the penis to be held 
out and a little downward, which position brings the 
urinary passage as nearly as possible to a straight line — 
the curve being much reduced. In introducing a Bougie 
it should be held in this position as soon as the instru- 
ment is about two-thirds of the way in, i. e., as its point 
reaches the commencement of the curved portion of the 
passage. 

D D, — Shows the Bougie in the first and second of 
these positions, in introducing it. 






PLATE VII. 




pass at all. But suppose you pass it smoothly and easily 
down a certain distance, and then it suddenly stops ; in 
this case you are to withdraw the instrument about an 
inch, then lower the outer end and the penis together so 
as to tilt the point still more upward, and resume your 
attempt to pass it on, at the same time stretching out the 
penis more, as it were pulling it over the Bougie. Pro- 
ceeding in this way the Bougie will, if there is no obstruc- 
tion, pretty easily enter the bladder. 

The manner of Detecting a Stricture in its Early Stage. 

Now, I have before said that Stricture, in its early 
stage, offers little or no resistance to the passage of an 
instrument ; — how then is its existence to be discovered ? 
It is in the following way: Bring to mind the nature of 
Stricture in its early stage, you will recollect it consists 
in a tumefied or swollen spot, very sensitive or even pain- 
ful to the contract of an instrument, giving the idea of a 
sore being touched. But, in a healthy state of the urin- 
ary passage, such a sore spot never exists ; the neck of 
the bladder, indeed, is very sensitive, but the sensation is 
altogether different ; you feel, when the instrument touches 
the neck of the bladder — that is, as it enters the bladder 
itself — as if you must urinate, — it feels difficult for the 
moment to hold the urine ; and which is also a great dis- 
tinguishing mark, it is from seven to nine inches up the 
passage, — whereas, the tender Stricture-spot is between 
four and six inches up, very seldom beyond six, and I be- 
lieve almost never beyond six and a half inches. This 






.statement may be relied on, — it is founded upon a great 
number of cases minutely recorded in my Case-Book. 
Remember the subject is Stricture.* 

Now, having proceeded with the introduction of the 
Bougie as described in the preceding page, if the early 
stage of Stricture exists, when the instrument comes to 
this point it will give so positive a sensation or sorish 
feeling as often to lead you to believe it cannot be passed ; 
this however is imaginary, — hold the instrument steadily 
there for a moment, the spot will become accustomed a 
little to the touch, and the Bougie will pass through. Of 
course this tenderness varies in degree in different indi- 
viduals and in different conditions of health; it is always 
however, sufficiently decided to determine the question. 
A medium size Cylindrical and quite blunt Bougie must 
be employed, — a very small one would he improper for 
such an examination. 

In the Dilatable Stage : — The Stricture may however 
have passed this early stage, being perhaps in the next or 
dilatable condition. We will suppose.then, that the Bougie 
has passed quite easily down a certain distance, and then 
is suddenly stopped, and you find that even by managing 
as was before directed, it will not pass on ; you then hold 
it steadily to the part, gradually, and to a limited and 
reasonable extent increasing your pressure. This is the 

* When this soreness is further in, (neck of the bladder) or the diseased 
it generally indicates either a degree of state of the Seminal organs peculiar to 
inflammation of the Prostrate Gland masturbation. 



strictured part, and if it be dilatable, the Bougie will pre- 
sently pass through, and you will have accomplished the 
first step towards its cure. There is seldom more than 
one Stricture whilst the disease is in this stage, and this 
one, as was before said, is generally situated at between 
four or six inches from the exiernai orifice of the passage. 
If there is another, it will generally be only an inch or 
two in, and would therefore be met with first. Thus 
when you detect a Stricture very near the orifice, you may 
reasonably expect to find another further down, but not 
always. 

In the Advanced or Callous Stage. — But suppose 
you come to a Stricture, and, after perhaps a second trial, 
you find you cannot pass it. In this case then you are 
to withdraw that Bougie and try a smaller one, exact- 
ly as before; (remember a medium was recommended 
to begin with) and if this will not pass then take a 
smaller still. But it may happen that the smallest will 
not succeed. Indeed the part may be so irritated by 
these frequent attempts, that it will not pass on the first 
trial at all. I have frequently succeeded well at the 
second when I have failed at the first. In general there 
is but little or no pain in passing a Bougie, and the de- 
gree of force is so limited that there would be none felt 
on that account ; except the Stricture be in what is called 
an irritable state, which is known by its giving pain im- 
mediately on touching it, and then it should be postponed 
until this has been relieved. What I mean is, you must 



not give much pain by the mere force of pressure. Nei- 
ther should you go on with an attempt at any time if it is 
disposed to bleed. A drop or two of blood is of no con- 
sequence ; the part is so delicate and vascular that a drop 
may appear on a slight occasion ; but, if there is more 
than a few drops, this should induce you to lay aside 
the attempt for the present. In some cases you may not 
be able to pass the smallest size till after various attempts 
made at intervals of several days; this however but sel- 
dom happens ; when it does, you must pay attention to 
your state of health and habits. Particularly must you 
pay attention to the state of your stomach and bowels. 
Take a moderate dose of the Purgative Diuretic Pills 
from the case, or any other in note 1, avoid a stimula- 
ting or full diet, and rest as much as possible. A warm 
bath too is very advisable, but if this cannot be had, bathe 
the parts well with hot water and a large sponge every 
night, or night and morning. These directions however 
will seldom be required, still it is necessary to give them. 

As to Stricture at or near the orifice or entrance of the 
passage — this is known at once when a Bougie is found 
to enter or pass tightly, and yet does not completely fill 
up the lips or orifice of the passage. 

Injections. — Although it is not at all generally under- 
stood, Injections, even where there is no Gleet or Dis- 
charge, are useful in the treatment of this complaint; 



their effect upon the Stricture is peculiar and excellent, and 
is exerted through the medium of the delicate skin lining 
the urinary passage, and by the condition of which the 
Stricture itself is greatly influenced. But two kinds, as far 
as I have discovered, are efficient, viz : the White Vitriol 
and the Nitrate of Silver in very diluted form. 

§5. 
The Cure of Stricture. 
The cure of Stricture can be accomplished only by the 
use of the Bougie. Medicine occasionally assists, but the 
Bougie is that without which you cannot cure the disease. 

Success, in the treatment of Stricture, depends in an 
uncommon manner on the proper management of the means 
employed. 

The ultimate object in using the Bougie is to pass one 
into the bladder of such a size (whatever size that may be) 
as about fills up the capacity of the urinary passage, with- 
out stretching or giving pain at its external orifice :* that 
is, supposing the orifice to be healthy — that there is no dis- 
ease or Stricture just within it. 

When there is Stricture at the orifice, a Bougie that 
evidently does not fill the entrance or lips, is still more or 
less tight and painful.* 

It is usually necessary to commence the treatment with 
a Bougie several sizes smaller than the one with which you 
end it, and to reach a full size gradually. 

There is naturally a great difference in the size or ca- 
pacity of the urinary passage, amounting to at least double 
from the smaller to the larger. 



The following are the ordinary natural dimensions of the 
passage, as measured at the orifice •* the middle one may 
be taken as the average : 

ooooo 

Sometimes it is found smaller or larger. The measure of 
the size of the passage is taken at the orifice or entrance, 
because here and just before it ends in the bladder the 
passage is smaller than anywhere else ; and, therefore, what 
will enter easily ought to pass all the way. 

An occasional warm bath is very useful. Diet should 
be ordinary and moderate, strictly avoiding all alcoholic, 
beverages. 

* Sometimes the external orifice of the urinary passage is exceedingly- 
large — in which case there will usually he found another ring or circle a 
very little way inward, which is the true measure. 

Note. — Every part and structure of the body is endowed with its own 
peculiar power of action ; also, every part is endowed with a restoring 
power, the activity of which is aroused by every deviation from the na- 
tural and healthy condition of a part. This is no fiction. Indeed, every 
restoration from disease to health is an illustration as well as a proof of 
such a principle. Numerous as are the laws which regulate and maintain 
the healthy actions of the body, these are not more numerous and impor- 
tant than those which influence and control its morbid actions. A Stric- 
ture is essentially a morbid action — a deviation from the healthy and na- 
tural condition of a part ; it has lost is natural elasticity, and if that morbid 
action which destroyed this elasticity could be removed, the principle I 
allude to would instantly restore it. 

Now the Bougie does this. The pressure and excitement of the Bougie 
upon this delicate structure breaks up and destroys this morbid action 
and the healthy one immediately succeeds — the natural elasticity of the 
passage is restored. 

On the same principle also are the confirmed and callous Strictures 
cured. Every part of the body is endowed with the principle of absorp- 
tion. The Bougie, in this case, aided by another powerful remedy, not only 
destroys the morbid action essential to the Stricture, but powerfully ex- 
cites the action of thj absorbent vessels, which is the means of removing 
that callosity. Indeed the cure of Stricture is effected by tha Bougie 
on the same general principle on which every other disease is cured — it 
interrupts or destroys a morbid action, when a healthy one succeeds. 



12 



The Treatment of Stricture at the. orifice is conducted 
in the same way as when sealed further inward, with this 
little difference, — it is only neces>ai y to pass the Bougie 
in an inch or two, or a iiitle beyond the diseased spot. — 
it will more frequently bear the use of the instrument 
every day without bringing on an mitation; it is likely 
to be rather slower in its cure. There is so very com- 
monly a Stricture at the other end also when there is one 
at the orifice, that, even where it is not evidently the 
fact, it would be wise occasionally during its treatment, 
to pass the Bougie all the way into the bladder. 

We sometimes hear of Spasmodic Stricture. On this 
subject much misconception has existed. It may be ad- 
vantageous however to know that the muscuiar fibres 
around the mouth of the bladder, designed to retain the 
urine, and also those fibres a few inches up the passage, 
designed to throw out the urine with a jerk, are both 
under the influence of a Stricture, and when this is 
rendered irritable by any cause, the action of these mus- 
cular fibres is quickly disordered. It is in this way that 
spasm in these muscles is so ofl n brought on in persons 
after drinking,— the excitement of wine and company 
having made the Stricture irritable. In this state per- 
haps he goes out of the room to make water, but finds 
he cannot make a drop. The fact is, the moment a drop 
of urine touches the irritable strictured part, the muscles, 



of the mouth of the bladder are thrown into a state of 
spasm which prevents the urine passing. Neither can 
you always draw it off, in this case, by the catheter or 
hollow Bougie. The best plan is to foment with warm 
Water and take an opiate. If this will not do, bleeding 
and the warm bath must be superadded. So also, in pass- 
ing a Bougie, if the Stricture has been rendered irritable 
by any such cause, ihe moment it presses on it, these mus- 
cles itre thrown into spasmodic action which hinders its 
passing through. In this case keep the Bougie gently 
pressing against the Stricture for some few minutes, — it 
will frequently succeed by this means, — if not, desist, 
and give an opiate, &c, as before directed. In some 
hours afterwards perhaps you may pass it easily. 

But there is another state of things for which the 
Bougie is a remedy, beside a Stricture, and that is, a sim- 
ple stdte of tenderness (without Stricture) extending along 
half or a quarter of the passage, and toward either end or 
portion of it. Being led to examine the passage from 
symptoms warranting the suspicion of a Stricture, it is 
found that the Bougie passes perfectly well, so far as ob- 
stiuction is concerned, but, that along a certain distance a 
great degree of pain is felt. This disorder is different from 
a Stricture, inasmuch as it consists merely in a diseased 
or increased degree of insensibility, but it is to be treated 
exactly as though it were a Stricture. Pass the Bougie, 
a medium, or above a medium size, every day, or every 
other day, as the degree of irritation will admit, and keep 



the bowels and digestive organs in a regulated and healthy 
state. The effect of this treatment, very generally, is to 
lessen and ultimately remove this morbid sensibility. If 
therefore, on every time of passing it, you find the pain 
and tenderness become less and less, you may depend 
upon a perfect cure, as well as the cessation of every 
symptom which originated from it. 

The Treatment of Stricture in the more advanced Stages 
is as before said, totally unfit for private hands. When, 
however, a person laboring under this cannot procure pro- 
per assistance, it is encouraging to know how he may very 
much relieve his condition, and to a considerable degree 
open the passage; generally, at least. The means of 
doing this are, — great attention to the state of the bowels, 
especially with reference to their free and easy action, — 
the use of cooling drinks when irritation is present ro of 
Soda, the use of the injection for Stricture, sometimes 
adding to it (if that composed of Zinc is used) one drachm 
of Laudanum. — and the use of small Bougies, conic, when 
such can be obtained. It may be very difficult to get even 
the point of the smallest Bougie to enter the contracted 
spot ; when this is the case and even a partial entrance has 
been secured, the Bougie should be allowed to remain in 
for some time, half an hour or an hour. A great deal of 
tact and management is often required, but always in 
*uch cases, keep in view as the most important of all 
•dvice, never to irritate — to do too much at the time. 



On the application of Caustic to the cure of Stricture 
little or nothing has been said in this volume, because, 
in a work of this nature such treatment only should be 
given as is safe and practicable for domestic or private 
use. And again, it requires particular and expensive in- 
struments, which, even if the patient could obtain, he 
could not use. I ought also to add here, that great mis- 
apprehension exists with regard to Cauterization; it is 
by no means, as now employed, the dangerous and pain- 
ful operation that every one supposes, but quite the con- 
trary. 

Another operation required in some old and indurated 
cases, is Scarification. The operation is one of great 
nicety in its performance, but is attended with very little 
pain, and, in experienced hands, no danger. 



12 



PART THE SECOND. 



CHAPTER X 



On Masturbation, — called also Onanism, Self-Pollu~ 

tion, fyc. 

The power or influence exerted by the Generative Or- 
gans over the body, its different organs, tissues, and even 
the moral and intellectual faculties, is immense, it is ab- 
solute, and to those who have never studied the subject, 
might seem at first almost incredible And this influence 
is exerted from the first moments of life to its decline ; — in 
this place, however, we shall consider it only in youth, 
t. e., from infancy up to the period of puberty, during 
which time these parts are in a state of inactivity or repose, 
seeming to slumber, or, to common observation, as serving 
no other purpose than a mere passage for the urine. 

In the following pages of this Chapter I am much in- 
debted to a very celebrated French author,* whose excel- 
lent mode of illustrating this subject I have adopted. 

* M. Deslandes. De l'Onanisme, et dans leurs rapports arec la Santt.-— 
<les autres abus veneriens, ccnsid£r63 Paris 



Masturbation, is an abuse of the parts which serve to 
execute the sexual act, — the Genital Organs. These are, 
thus, placed in such a condition that they become to the 
rest of the body, a source of disorder of deterioration, of 
disease. But, what is their power in this respect? Placed 
in a condition to injure, how greatly can they do so ? 

The injury which the genital organs may inflict upon 
the rest of the body when they are abused, i. e., when 
subjected to Masturbation or any other improper use or 
excess, is the natural consequence of the influence they 
exercise when not abused. The injury is in a direct ratio 
with the influence; it is, therefore, by this rule that the 
injury should be calculated. It is plain, indeed, that if 
the various organs of the body possess, in their ordinary, 
natural, and healthy state, different degrees of influence, 
they must, when they become injurious from disease or 
abuse, be so in different degrees. Let us then endeavor 
to arrive at that which the generative organs possess. If 
it is proved that when they are in a state of inactivity 01 
repose, that is from birth up to puberty, their influence is 
great, the question of what it may become when they are 
in a condition of abuse, can be judged. 

One might believe that these organs, — when they are 
in this state, when neither used or abused, when the sex- 
ual power sleeps, when they appear to be occupied only in 
themselves, in their own growth, — were taking no part or 
but a very feeble one in what passed on around them in 



ihe other organs and tissues of the body : we should be 
much deceived. We shall see that this apparently inac- 
tive life which animates them, already suffices to make 
them a powerful focus of action ; that all the other organs, 
all, owe to them a part of their mode of being, of their 
form, of their substance. From this we shall be able to 
judge of the generative organs when aroused, — when, by 
the hand or otherwise, their action is carried to the very 
highest degree to which it can attain : — look at the eunuch 
from infancy, the man who never has had any genital 
organs, whose body, mind and soul has been developed 
without feeling their influence. Seek, in comparing him 
with other men, wherein he is wanting; for in his physical, 
intellectual and moral aspects, he ought to be wanting in 
all that these organs would have afforded. This study 
will reveal to you their influence, in showing you the dif- 
ference between the man over whose growth they have 
presided and the one who has grown up without them. 

Eunuchs are never tall ; often they are even small, and 
sometimes very small. Their limbs, when they are not 
swollen by the weaker fluids of the body, are generally 
thin and badly formed. Their bones neither acquire the 
ordinary length or form. This defective growth is even 
still more remarkable in the throat. That organ which, 
at puberty, commonly acquires two thirds of its size, re- 
mains as in childhood ; thus the voice retains, in eunuchs, 
that sharp tone that it has in childhood, and if it gains a 
little more strength, it is only from the increased size of 



the chest. Not only are the various parts of the body 
checked in their growth, but some of them are not formed 
at all. Thus in eunuchs there is no beard, no hair about 
the sexual organs, — the skin remains naked as in infancy. 
The genital organs then interpose a powerful influence 
over the nutrition of the body, since, when they are want- 
ing, development is but ill or not at all accomplished. 
But this interposition is again manifested by the charac- 
ters which the different parts present when they have been 
deprived of the influence of the generative organs. To 
appreciate these characters we have only to compare the 
flesh of animals which have undergone castration with 
that of others; for example, to compare, in this respect, 
the ox with the bull, the wether with the ram, the capon 
with the cock, &c, &c. In the eunuch, these characters 
are not less striking. His organization is, as it were, at 
a stand-still. Arrived at an adult age, he preserves to a 
great degree the physical attributes of adolescence, and 
w T hen he loses these, it is to be gradually invested with 
old age, without ever having passed through those of 
manhood. It is then the genital organs which, in the un- 
mutilated man, color and strengthen the skin, give to the 
flesh more firmness, and by degrees free the tissues of those 
whiter fluids through which we should in vain seek the 
full forms of the bone and muscle. The organization of 
the eunuch is then unfinished, incomplete. Organs which 
ought to have appeared at the epoch of puberty are not 
to be found; others acquire but a portion of the substance 
they should have had: they all preserve some of the 



characters they ought to have lost, and witnout gaining 
those they ought to have acquired. These facts are of 
great importance. Their study, better than any other, 
indicates the extent of* the evils which sexual excesses 
may cause ; for these organs, which the Masturbator and 
the libertine so abase, are those very organs which take a 
fart so active, so profound, in the internal life of all our 
tissues, which impress upon them that stamp of virility 
that the eunuch remains forever deprived of. 

Let us now consider him in his life of relation; seek in 
him the active, feeling and thinking man In this re- 
spect, also, how much has he lost! he is a bad walker, is 
supine, without energy : you will see him sew or embroi- 
der, but never raising heavy burthens. Not less than 
the flabbiness of his muscles and the whiteness of his 
skin, his apathy, his want of sensibility, render him the 
very type of the lymphatic temperament. He has pre- 
served from his infancy that disposition given by weak- 
ness, to be affected, to tremble from the slightest cause ; 
hence, he is timid, pusillanimous, cowardly. Deprived 
of that internal influence which renders the soul cheerful, 
he is morose, wearisome. Those sentiments which bind 
an individual to his fellows, which render him capable 
of attachment, of love, of devotion,— he is deprived of. 
He lives, he vegetates only for himself; he is the most 
perfect egotist. If he feels any sentiment, it is hatred or 
envy, — they are the repulsive sentiments; but he oftener 
feels none at all or but very feebly. His mind having, 



like his body and his soul, lost its impulse, remains in- 
complete. He has but a moderate intellect, and is never 
known to conceive nor to execute great projects. This 
picture, let it be well understood, is not drawn for diver- 
sion; it is the result of positive observations made in all 
times, in every place, and on every species of eunuchs. 
One, spoken of by M. Bedor, bore in himself the charac- 
ters of this picture. It was an eunuch from birth, whom 
the conscription of France had made a soldier. His man- 
ner was humble and languid, his hid and sunken eyes 
seemed unable to sustain the look of another; far from 
martial, he was timid, pusillanimous, fearing the dead and 
especially darkness. By his own declaration he had never 
been attached to any one, even in his own family; and 
also he was incapable of aversion. Music did not please 
him, and never had he any idea of singing; he experi- 
enced no kind of enjoyment; neither did he complain of 
his lot. His intellect was restricted, his language obscure 
and incorrect, and education had so little effect upon him 
that although he had lived a year in the barracks he had 
in no way contracted the ways of the soldiers. 

Such is the eunuch. The operator, in mutilating him, 
has mutilated his soul, his feelings his mind. The growth 
of the moral and intellectual powers then is connected, 
like that of the body, with the existence of the generative 
organs. You might deprive an infant of a limb, of his 
four limbs, that is to say of at least the half of his sub- 
stance, but the growth of the rest would go on as if this 



ablation had never taken place. But take away nis tes- 
ticles — all his tissues, all his faculties, will bear the in- 
delible marks of this mutilation. These organs then 
possess, in themself alone, an influence more powerful 
than his four limbs together. Now, it is with them, with 
this power, that the masturbator trifles even from his 
childhood, at every moment, without scruple, without 
limit. Is there still need to follow out this trifling in its 
fatal consequences, in order to declare it dangerous ? 

Again, it is to the influence which the generative or- 
gans exert over the rest, that the sexes owe the general 
characters which separate them. Submitting to the influ- 
ence of a different genital apparatus, their organization 
presents a different mode of being, acting, feeling. Thus, 
observe how the sexual characters, indistinct at the mo- 
ment of birth, grow more evident in proportion as the 
sexual parts are developed, become at once distinct when 
puberty arrives, existing at their greatest height, when 
these parts have come to their perfect state, and again 
effaced in old age. The destruction of the testicles in 
man, and the ovaries in woman, has the effect to hin- 
der the regular developement, or even to alter the 
special sexual characters. We have already seen that 
this destruction effeminates man; we now add that it 
renders masculine the woman, gives her those characters 
which, in the natural order, are the exclusive appendices 
of the male sex. This is proved by well-authenticated 
facts. And do we not see when age extinguishes in wo- 



man the activity of her sexual organs, puts them aside as 
it were, her voice becomes harsh, more masculine, her 
upper lip and chin grow hairy, her moral character ac- 
quires more firmness, her tastes, her habits become greatly 
changed, and approach nearer to what they are in man. 
The same thing takes place in animals. 

It is not only the comparison of the two sexes which 
shows that different genital organs have a different influ- 
ence. It is also shown by observation of those beings 
of doubtful sex, named hermaphrodites. In these indi- 
viduals, the genital organs, disturbed in their regular for- 
mation, present equivocal appearances belonging at the 
same time to both sexes. And we find that the organi- 
zation of these individuals being differently influenced, is 
differently developed. Faithful to these organs, which 
impress upon it the sexual stamp, the general condition 
of the body becomes equivocal like them, and presents a 
mixture, in various degrees, of the female character and 
that of the male. The general state of the economy, 
then, reflects, to a certain extent, that of the generative 
parts; varies with them, and has its share of the altera- 
tions which they undergo. After all this, is it astonish" 
ing to see libertines and masturbators become effeminate, 
•pervert their constitution by making a use of these parts 
which fatigues and deranges them ; — and girls lose, in 
the same way, their beauty, the delicacy of their forms, 
and the charm of their voice. 



13 



The period of puberty, which commences at from 
twelve to fifteen years in our climate, a little sooner in 
girls than in boys, is that in which the genital organs 
exist in their greatest vigor. Until then, they were de- 
veloped but slowly, and in a manner almost insensible; 
suddenly they begin to increase with great activity, and 
this growth is not arrested until they have arrived at their 
perfection. At no other epoch of life does the increase 
of the substance of the body take place with such energy 
as at this. The researches of M. M. Quetelet and Pil- 
erme, on the weight and stature of men of different ages, 
leave no doubt on this point. Thus the annual increase 
in the weight of the body, which, up to the age of pu- 
berty, was only from three to three and a half pounds, 
suddenly increases to five and six pounds when this pe- 
riod commences, and goes up to above twelve pounds, 
when it is at its height of intensity. And what is worthy 
of remark, in girls, in whom puberty is more precocious 
than boys by about two years, this increase of nutrition 
also commences two years sooner. An analogous fact is 
observed in those exceptionable beings, or monstrosities, 
who present from infancy the characters of virility : in 
them the bulk of the body is in a direct ratio with the 
genital development : hence their stature and weight are 
enormous. Connect then these facts with those just 
pointed out in speaking of eunuchism, and it will rest 
well proved that the influence of the genital organs over 
nutrition follows out, in its variations, those which them- 



self undergo ; that the general growth is in conformity 
with theirs, progressing if theirs progresses, and being 
accomplished but incompletely or badly if theirs is hin- 
dered. 

This redoubled activity of the nutritive process during 
puberty is not only revealed by the increase of the sub- 
stance of the body, it is also manifested by other symp- 
toms. Thus, more animal heat is generated in the body, 
this is clearly shown by the ease with which pubescents 
resist or bear cold. And, at the same time, indispositions, 
illness of all sorts, demonstrate in most such subjects, 
that the influence of the generative organs over all parts 
of the body may go so far as even to derange the various 
functions. Indeed, the body reflects like an echo all that 
goes on within the generative apparatus. Need it be 
added that in eunuchs nothing of the sort happens f 

The active development of the genital parts exercises 
no less influence over the functions of the life of relation, 
over the faculties of feeling, acting, thinking. These 
faculties, of which the eunuch is so deficient, are, during 
puberty, in the height of their action. It is the age of 
muscular activity, of agility. If pubescents sometimes 
experience indifference for exercise, this, resulting from 
plethora of the nervous system, soon passes over. The 
moral susceptibility is now even more exalted than the 
physical. The mind, directed, excited, by the most lively 
and varied impressions, imagines, abandons, resumes opin- 



ions the most opposite, adopts and would accomplish pro- 
jects the least calculated, and sometimes the most hazard- 
ous. But what above all characterizes the mental con- 
dition resulting from the operations of puberty, is the fa- 
cility with which such participate the affections of others, 
are interested in their interest, forget themself for them, 
sympathize with them. It is the moment of generous 
ideas, or, as s-ay those whose minds no longer feel the in- 
fluence of organs that are become mute, the moment of 
illusions. How great development, what trial must the 
mind reap in passing through this moral tempest ! Can 
we then be astonished to find weak intellect, cold hearts, 
benumbed feelings, in the eunuch 1 Deprived of those or- 
gans which, at the epoch of puberty, agitate so power- 
fully, they have never felt it; the most active of all mo- 
ral excitants has failed them. Judge then of its power ; 
and yet. it is this — this is the excitant, that the masiur- 
bator dreads not to abuse ! 

Assuredly, those who have not feared to say that the 
possible consequences of sexual abuse anil excess have 
been exaggerated, have not reflected upon all this. 



CHAPTER XI 

On Masturbation. — Its Consequences. 

All authors agree that sexual excesses and abuses, 
and especially Masturbation, constitute a prolific seource 
of disease, and to an alarming extent, of deterioration in. 
the human race. 

There is no disease or infirmity which Masturbation 
may not, in one way or other, directly or indirectly, be 
the cause of. Many serious and fatal disorders of the 
nervous and circulating systems are the direct consequen- 
ces of it — while others to which the constitution was lia- 
ble from predisposition, (as hereditary influence, weakness 
of particular organs, &c), are developed or brought out 
under its influence, when otherwise the power of nature 
might have outgrown or overcome them. Innumerable 
cases, in proof of these assertions, might be adduced, — 
every work on this subject abounds with them. I intend 
here, however, only to state the fact, leaving the rest to 
the good sense of the reader — especially to those who 
are, unfortunately, more interested in such knowledge. 

In this Chapter I propose to enumerate briefly those 
forms of disease which have most frequently and most 
clearly been known to be caused by Masturbation, and 
which may, for convenience, be classed as follows: 

* 13 



§• — Diseases directly or indirectly induced by its effect 
upon the rest of the body. 

Consumpti n is, of all the fatal diseases, that most fre- 
quently developed under the depressing influence of sex- 
ual abuse. Where an hereditary or I a Daily predisposition 
exists, Masturbation rarely fails to bring it into action. 
It is impossible to estimate the number of individuals who 
thus yearly fall a prey to Consumption, th^ir friends and 
parents generally little suspecting its real cause, and who 
might, in most instances, have outgrown the tendency to 
this disease, had not the blight of Masturbation arrived 
at the very moment their constitution was in need of all 
its vigor and resbuice. 

Insanity is another of its frequent and terrible conse- 
quences: look at the reports of all lunatic asylums. The 
nervous system, of which the brain is the great centre, 
always suffers early and seriously, from Masturbation. If 
we reflect upon the dejection and depression of spirits and 
of all the higher faculties of the mind which characterize 
the victims of this habi;, we must rather wonder that the 
wreck of intellect is not still commoner; it is possible 
that many of those cases of insanity whose cause is un- 
known are in truth due to this.* 

Epilepsy very frequently has this origin, as also various 
other convulsive affections, palsies, &c. Even positive 

* A severe rase ol this kina came Tin- tunat< ly yieled entirety to a treatment 
lev my observation last winter, it for- principally moral and dietetic. 



destruction of the brain itself has been distinctly ana un- 
doubtedly traced to it. Loss of speech, as a variety of 
pcdsy, sometimes happens. A case of this kind came un- 
der my own observation last year, — in a young man from 
Rochester, in this Siate, about 18 years of age; his ap- 
pearance was pale and haggard, his eyes inexpressive 
and downcast; he was weak, trembling, emaciated, and 
his behavior decidedly silly. A week or two previously 
he had suddenly lost his voice and could not articulate a 
single word ; he carried a slate, by means of which he ex- 
piessed himself. Loss of memory, more or less, is very 
common. 

Disease of the Spinal Chord — a prolongation of the 
brain and fully as important in the animal economy, is 
also among the frequent consequences. Nor is this to be 
wondered at, every Masturbator, as well as those who 
commit sexual excesses, even in the most legitimate man- 
ner, soon complain of weakness of the back and especially 
of the loins, — and this, if the cause is continued does not 
fail, at first merely following each abuse or excess, to be- 
come at length permanent. Disease, and even destruc- 
tion (caries) of the back-bone itself, have repeatedly had 
this origin. Also, permanent contraction of the limbs, 
crooked or hooped backs, &c. 

Diseases of the Eyes. Sudden blindness, or the more 
gradual approach of Amaurosis, Chronic Opthalmia, 



Strabismus or Squinting, &c. What Masturbator has 
not observed his eyes become red, watery, swollen, assume 
every appearance of a degree of inflammation, immedi- 
ately after his unnatural efforts ? Who among such is 
not also aware that his eyes are becoming more and more 
weak — that he cannot work or read by candle-light? 
symptoms known to be the precursors of loss of sight. 

Diseases of the Heart are also directly induced by sex- 
ual abuses and excesses. The circulating system is al- 
ways deeply agitated and excited by these acts; and 
when too often repeated, or excited in an unnatural way, 
it cannot be wondered at that a permanent derangement 
should at last set in. What but a threatening of such 
disease is the palpitation, the short breath, that so con- 
stantly attend the abuse of the sexual organs. 

Rheumatism, as supposed by many, is more frequently 
than is generally imagined, the consequence of the gene- 
ral prostrating effect of Masturbation on the nervous sys- 
tem ; especially a form of Nervous Rheumatism. 

Asthma, short breath, and especially a kind of Ner- 
vous Asthma. 

Piles. The morbid attraction and detention of blood 
in the lower abdomen, where the genital organs are situ- 
ated, together with the general debility accompanying, 
is necessarily a frequent cause of Piles. 

Fevers. Sexual excesses and M?,sturbati .. become the 



cause of Fevers, because, by weakening the system gene- 
rally, they deprive it of its naturally inherent power of 
resisting diseases; hence, the moment such person is ex- 
posed to an atmosphere bearing an epidemic poison, as 
Cholera, or the more local miasmatous poisons, as Yel- 
low Fever, it at once yields, the fever is caught ; Nature, 
deprived of her internal power of repelling injurious in- 
fluences, stands an unfair chance — she surrenders. 

While on this subject, let me reiterate some valuable 
and important advice, viz : That all persons, whether in 
good or bad health, refrain from sexual intercourse on ar- 
riving at tropical or unhealthy places, until they have be- 
come, at least to some degree, acclimated. It constantly 
happens, more particularly to Europeans, that one single 
sexual act throws the constitution open to Fever, which 
would not have been taken but for a too early indulgence. 

§. — Diseases directly induced in the Genital Organs. 

An Eruption on the Prepuce, generally towards its 
edge; it commences with little watery pimples, and after 
a time spontaneously subsides, to appear again however. 
This is sometimes the cause of permanent Phymosis. 

Gleet, or discharge of matter from the urinary passage. 
This often happens, it is generally very slight and but 
little mattery — sometimes, however, it is copious and 
purulent, and occasionally has al! the characters of Go- 
norrhoea or Clap. 



Disease of the Testicle- Those who abuse their sexual 
organs seldom escape without some injury to the testicle, 
but which, very fortunately, for a long time exists in a 
sympathetic form only. Such persons always have a 
weakness or hanging down, an occasional shooting pain 
running up towards the groin, or an unnatural tenderness 
and flabbiness of these organs. Cancer, Dropsy, Wast- 
ing away of the Testicle may result. A hard and pain- 
ful swelling attached to one side, or a swollen spongy 
state of the veins of the chord, in its nature very much 
like Piles, are quite common. 

Incontinence of Urine and Retention of Urine, may 
both be caused. A milder form of incontinence of urine, 
consisting in a very frequent desire to urinate, with more 
or less inability to hold it, is very common. I have seen 
several cases of complete retention of urine, from spas- 
modic derangement of the muscles concerned, which have 
lasted until relieved by the passage of an instrument. 
With these there is often some slight pain or uneasiness 
in urinating or at other times. 

Stricture, as stated in Chapter ix. may be the conse- 
quence of the irritation produced and continued in the 
urinary passage by Masturbation. Several of the most 
severe and obstinate cases I have had to treat have been 
from this cause. 

Inability to perform the Sexual act. If the erectile 
power has been brought to such a state of excitability 



that tbe slightest cause suffices to produce an erection^ 
why should not its termination be as hurried, if the same 
cause continues to act? — It is especially so in this case ; — 
in attempting actual intercourse with a female, an emis- 
sion precipitately takes place, before the act ought to be 
half completed, often at the very commencement, at the 
first moment of the attempt, to the great mortification 
of the individual. This is one of the earliest injuries in- 
flicted on the sexual faculty by Masturbation. 

Seminal Emissions. These, at first, are rare, happen- 
ing only in one or two weeks, and are accompanied by a 
dream ; by degrees they become more frequent, — though 
accompanied by a dream, they do not wake the person ; at 
last they happen almost or quite insensibly — even without 
erection — day or night, on the slightest provocation. No 
one who has not seen it can conceive the miserable condi- 
tion of a person arrived at this stage of Seminal Emissions, 

Constant Erections of the Penis, more or less attended 
with pain, quite out of the control of the will, devoid of 
any pleasurable sensations, is almost sure to follow long 
abuse, or, which is almost the same thing in a less degree, 
an erection produced by the slightest touch, by the sight 
of a female, or by lascivious ideas which are constantly 
haunting the imagination, and attended by a frequent dis- 
cbarge of semen. This latter, in a slighter or incipient 
form, must be familiar to every Masturbator. 

Palsey, or total loss of sensibility of the Genital Organs, 



ma j at last take place, it is the natural ultimate effect of 
inordinate excitation. In this condition, not even Mas- 
turbation, much less sexual intercourse, is capable of af- 
fording the usual feeling, or indeed sometimes any at all 

§. — The Special disease of Masturbation 
In the long list of diseases just enumerated as conse- 
quences or effects of sexual abuses, either one of them 
may or may not be present in a given case ; seme of them 
are very frequently met with, others more rarely, while 
some of the latter are pretty constant, to one degree or 
other happening in every case. But there is a certain 
diseased state of the Genital Organs consequent upon the 
abuse which is never absent in any case whatever, and 
which I here call the special disease of Masturbation, and 
upon this one depend many of the other disorders, func- 
tional or otherwise, of the Genital Organs themselves, as 
well as some of those of the brain : it is, essentially, a 
Chronic Inflammation of the urinary passage- — of that 
portion of it near the neck of the bladder, into which open 
the seminal ducts. This special disease is of more real 
importance than any of the others, because they are all, 
to some degree, influenced by it, and cannot be cured un- 
less this is first removed ; and also because the first and 
most important part of the treatment must be directed to 
it, for any chance of success. It is also important because 
It is generally but little understood, and by practitioners 
in general is too often totally overlooked or forgotten. 
Almost every patient 1 treat is a proof of this last assertion. 



The Special disease of Masturbation, then, is a Chronic 
Inflammation in the urinary passage, at its inward ex- 
tremity, being seated immediately in front of the neck of 
the bladder. But it may extend several inches forward 
along the passage, — or the whole passage may be unna- 
turally sensitive or irritable, exactly as mentioned at page 
162, under the name of "tenderness of the passage" — 
but the most decided and acute inflammation will always 
be found near the bladder. 

As I have before stated, Stricture is sometimes the con- 
sequence of Masturbation ; this inflammation becoming 
after a while so' concentrated in space, so localized in 
certain points, that besides the general and extended ten- 
derness, one or more distinctly swollen or tightish spots 
are found to exist, or the exploring bougie may be ar- 
rested by a positively thickened and contracted spot, an 
actual Stricture. 

Commonly this inflammation is found to begin at about 
six or seven inches up the passage and extends inward to 
the bladder, perhaps between the seventh and ninth or 
tenth inch from the external orifice; — further onward 
than Stricture is found, as will be seen by referring to 
page 150 ; though the irritation produced, by Stricture 
may also extend backward to the bladder in the same 
way, and it is then that Stricture gives rise to many symp- 
toms belonging more particularly to Masturbation. 

This special disease of Masturbation has been divided 
into three Stages : 



14 



EXPLANATION OF PLATE VIII. 

Figure 1. The back part of the Urinary Bladder, 
presenting a view of the Seminal Organs. 
A— The Bladder. 

B, B, — The Seminal Vesicles, two small lobulated 
bladders, the reservoirs of the Semen. 

C, C, — The Ducts or tubes leading (he Semen, as fast 
as it is secreted, from the Testicles into these receptacles. 

D, — The Prostrate Gland — through which the Semi- 
nal ducts pass to open into the Urethra or urinary pas- 
sage; shown at g, fig. 2. 

E, E,— -The Urethra; see pi. iv 

F, — Part of the Urethra. 

Figure 2. Interior view of the above. 

A, — The Bladder laid open, showing its inside. 

B, B — The Ureters. 

C, C, — The openings of the ureters into the bladder. 

D, D, — The Seminal ducts, leading from the testicles. 

E, E — The Prostrate Gland,— which, with 

F, — A portion of the Urethra, are laid open to show 
G, — The openings of the Seminal Ducts into the Ure- 
thra, just in front of the neck of the bladder, having 
passed through the Prostrate Gland. 



PLATE Vm. 





Figure 2. 



In the first stage, the inflammation consists, as I have 
iust described it ; the derangement of the Genital Organs, 
and of the Nervous System, is moderate ; none of the 
more serious consequences yet show themselves : in this 
stage it is very curable, and the patient may safely un- 
dertake the management himself. 

In the second, the inflammation is more intense ; the 
Seminal Organs are more seriously involved; Seminal 
Emissions become frequent, and effect the constitution, the 
mind and nervous system suffer severely ; the derangement 
of the Genital apparatus and its functions increases, diges- 
tion suffers : this stage also is curable, but can no longer 
be entrusted to the patient ; surgical assistance must be 
had. In both stages, time and patient perseverance may 
be required, but will assuredly be crowned with success, 
and often with perfect restoration of health and strength. 

In the third stage, ulceration of the Seminal Ducts has 
taken place ; the Seminal fluid is then watery, mingled 
with matter or blood, and escapes frequently, or even un- 
interruptedly ; a consumption of the whole body and often 
destruction of the mind, is evident, where indeed, some 
more rapidly fatal disorder has not intervened to end the 
scene. Nothing, in this stage, can be promised, but little 
done. 



CHAPTER XII 

On Masturbation. — Its Treatment, 

In the treatment of Masturbation, or the disorders re- 
sulting from it, the first and most important step, as it 
would seem almost unnecessary to say, is the prompt and 
perfect abandonment of the practice. This no one, espe- 
cially if he has read the two preceding Chapters, will for 
a moment doubt ; happy were it as easily done as said : — 
but it is often far from being so ; the whole moral force of 
the individual, aided by other means, must be summoned. 
For instance, every thing calculated to excite lascivious 
ideas should be strictly avoided, or such thoughts sup- 
pressed ; to this end the mind itself should be occupied in 
some interesting pursuit or business. Active bodily ex- 
ercise also is important; inactivity and especially sitting 
occupations, and still more especially in heated apartments 
being injurious. Solitude must be avoided, keeping as 
much as possible in society. Diet must be moderate, 
using a very small portion of animal food, or, which 
would be better, none at all, and no late supper. Perfect 
abstinence from all alcoholic beverage must be observed. 
The exercise taken during the day should produce suffi- 
cient fatigue to ensure sound sleep ; the bed should be 
hard, and the covering cool and light; a feather bed is 
quite inadmissible. Very early rising is important. Fre- 
quent cold bathing should be practiced. Another point 

• 14 



of very great importance is the state of the boweis; cos- 
tiveness is apt to prevail and must be prevented. The 
bowels should be kept naturally free and open, occasion- 
ally even taking a purgative dose. 

When nocturnal seminal emissions have not set in, or 
even if they have but slightly commenced, tlie above 
treatment, consisting- of merely hygienic measures will 
suffice -, indeed, the habit broken off, Nature in the ma- 
jority of cases soon restores a regular and healthy state. 
The simple discontinuance of the abuse, without any other 
means being taken, has constantly been attended with the 
most rapid and perfect restoration. 

We will suppose, however, that after some months, the 
person still finds himself nervous, weakly, troubled with 
frequent and easily excited erections, and perhaps with 
nocturnal seminal emissions happening every week or two 
or oftener; also having some of the symptoms of Inci- 
pient Stricture. A judicious plan of local treatment, 
directed to the special disease before referred to, and which 
in this case must be supposed to have become established, 
must be adopted ; afterward taking a rather tonic course 
of medicine, and resuming the before mentioned hygienic 
measures of cold bathing, exercise, &c. 

I must not close this subject without making a few obser- 



vations, which it is important that every one in any way 
nterested, should well understand and bear in mind, viz* 

When the derangement consequent upon Masturbation 
refuses to yield to the Hygienic measures stated at the 
commencement of this chapter, the special disease of the 
inner extremity of the urinary passage must be considered 
to have set in ; — it is then a disease requiring local treat- 
ment — it connot be cured by medicine. Be not deceived 
therefore by the specious advertisements that every where 
meet the eye, of various " Cordials" and " Elixirs" of 
wondrous efficacy in the cure of " Constitutional Debil- 
ity," Nervous Debility," " Impotence," " Incontinence," 
&c. &c., as the complaint is always called by these kna- 
vish traffickers. They always use the name of some cel- 
ebrated foreign physician ; in several instances I have 
seen their very advertisements copied almost verbatim 
from others I had before read in London. Such medi- 
cines are worse than useless. Your money is their sole 
object — disappointment their sure effect. 

In the treatment of any case, ever so slight a one, do 
not expect a rapid cure, you cannot have it ; time and 
perseverence, in this perhaps more than almost any other 
complaint, are absolutely necessary, — but final success 
may be relied on. 

Especially in regard to the symptom of Seminal Emis- 
sions do not expect a rapid cure. Indeed there is a fact 
relating to this point, which should be well impressed. 



upon the mind of every one at all interested, viz : that, 
in an adult, Seminal Emissions having once set in, they 
can never be totally arrested. Now, these Emissions do 
not always and necessarily imply disease, and this is the 
reason why it cannot be arrested. But, so far as there 
is disease in it, so far it can be arrested or cured. — This 
is the explanation: Nature intended man, at least occa- 
sionally, to cohabit, and hence the testicles are constantly 
secreting or forming, with more or less activity, the 
Seminal fluid, which by means of the proper conducting 
tube (a part of the chord of the testicle, see plate vm), 
is carried to tw T o little pouches or sacs destined to contain 
it; these are situated immediately behind the bladder, just 
about its neck or where the urinary passage begins. Here 
it collects and is gradually absorbed again into the body, 
to which, as is generally believed, it imparts strength and 
vigor. But if in an adult, and it is especially likely to 
happen under the stimulating effect of certain reading, ob- 
scence pictures or society, &c. &c , or merely from a na- 
turally large development of certain cerebral organs, the 
testicles produce faster than absorption removes, an Emis- 
sion must necessarily take place. Nature thus relieves 
herself of an undue accumulation. — The question then 
comes to be, — How often may be considered as natural 
and healthy ? and by what rule can one judge ? As to 
the first point, Authors agree that it may happen once in 
four or six weeks, according to the temperament, &c, the 
individual and organs being healthy : as to the second, in 



this case Emissions do not leave the person dull and lan- 
guid, while, if they are the consequence of a diseased 
condition, a very decided languor and dullness are always 
experienced, and which may even last a long time. 

Avoid, as much as possible, brooding over your condi- 
tion ; — this must be resisted. The progress will often at 
first seem unpromising, the cure slow, and relapses may 
repeatedly occur; but, be assured that perfect success 
awaits a steady perseverence. 

The Treatment of the Second Stage of Masturbation, 
is not adapted to private hands. 



PART THE THIRD, 



CHAPTER XIII. 



On Syphilis or Venereal Disease. — Its Distinguishing 
Marks, Nature, Symptoms, Progress and Consequences. 

Venereal Disease, in the first place, should be carefully 
distinguished from Gonorrhoea. In common conversation 
the word Venereal is often used in a general way, to ex- 
press both one and the other ; but this is not a proper 
way of speaking, for no two diseases can differ more, 
either in their nature, train of symptoms, consequences, 
or modes of cure. It is true, as was stated in the first 
Chapter, that Venereal, (also vulgarly called Pox), is 
caught in the same way as Gonorrhoea, and that both 
may be taken at the same time, if the female happen to 
be afflicted with both diseases ; still let it be remembered 
they are distinct and very different complaints. And this 
is the more important to explain, inasmuch as I find con- 
tinually, that among those who apply to me, very many 
have been taking, in Gonorrhoea, the medicines that were 
intended only for the Veaereal ; and, in Venereal, nos- 
trums intended for the §*& orrhoea. Now the medicines 



that are proper in Gonorrhoea never can cure Venereal, 
neither can those proper for Venereal ever cure a Gonor- 
rhoea, — hence so much waste of time and disappointment. 
And this is not the worst of it, for this mistake cannot 
be made without injury to the constitution, so that when 
the proper and necessary medicines are given in either 
complaint, especially in Venereal, the constitution is less 
able to bear them with impunity. 

In place then of a disease beginning with pain and 
heat in making water, and a discharge issuing from the 
urinary passage, as in Gonorrhoea, the Venereal disease 
begins with an ulcer or sore on some external part or 
other of the Genital Organs. It may begin in any part, 
but is seen most frequently on the extremity or head of 
the penis, or upon the internal surface of the prepuce or 
skin which covers it, for the reason that the texture of the 
skin in these places is thinner than elsewhere ; and, as 
the skin forms a bridle under the penis making a little 
fold which is calculated to retain the Venereal fluid, the 
sore is perhaps oftener found there than in any other 
place. — There may be at first more than one sore, but 
this does not often happen, there are but rarely many. — 
These parts are subject to other diseases besides the Ve- 
nereal, and which are infectious too, but these appear in 
crops, while the real Venereal generally commences with 
one solitary sore, and that usually appears at some period 
between the second and seventh day after exposure. The 



little ulcer then begins and proceeds in this way. First, 
there is a little pimple, but this is so small and attended 
with so little pain that it is often not observed until it 
breaks. When it breaks, however, it forms an ulcer which 
differs from every other ulcer in these parts or elsewhere, 
and is what is called a Chancre ; or it may begin as an 
excoriation, or crack, or from the very first as an ulcer, 
but so small and without any soreness as to elude detec- 
tion for days. Now, the principal difference between a 
Venereal Chancre and other ulcers is, that provided it has 
already existed a few days, the Venereal Chancre is sur- 
rounded with a hard, thick feeling substance which ex- 
tends around and underneath it. This is so peculiar to 
the Venereal ulcer that you may always judge of its na- 
ture by it. If therefore at any time you are in doubt 
about the nature of a sore upon the genital organs, just 
take hold of it between your thumb and finger, and pinch 
it up a little, and if you find it has this hard feeling edge 
and base, then it is Venereal, you may be quite sure it is 
so. But, although you may be quite sure a sore is Vene- 
real if it have this hard feeling edge and base, you are 
not to be quite so sure it is not Venereal if it be wanting ; 
for, as I shall presently have to show, this hardness is 
sometimes slow in forming, and sometimes it forms im- 
perfectly. It is, however, a valuable criterion, for when- 
ever it is present it settles the question at once, — it is 
Venereal. But, as I have just now said, a sore on the 
genitals may be Venereal and not have this thick and 



hard feeling, what is to be done thenl The follow- 
ing : — If it be a recent sore, wait a little, (unless you de- 
termine at once upon the abortive treatment, described 
at the end of Chapter xvm), and do nothing to it but 
watch its progress and keep it clean, — washing it often 
with water or soap and water. If it is Venereal, in a 
few days, in all probability, it will form its peculiar edge 
and base. There are but very few instances of Vene- 
real sores which do not, in some degree or other, present 
this character. But if this should not appear, or only in 
a slight degree, then some other characters must be looked 
for. Now, another peculiarity of a Venereal Chancre is 
to eat deep into the part, rather than to spread ; then, 
again, the surface of the sore is of a yellowish brown 
color — or is as it were coated with a tough layer of mat- 
ter of this color, — it is quite different from other florid, 
red sores which are frequently seen on these parts. Also, 
except any thing has happened to inflame or fret it, there 
is seldom very much pain about a Venereal sore. Per- 
haps the most correct description of a clear and well- 
marked Venereal Chancre is that given by John Hunter, 
a great and eminent surgeon, and the first writer who 
gave to the world any definite and systematic view of this 
disease. His words are these : " A Venereal Chancre is 
a sore of a somewhat circular form, excavated, without 
granulations, (that is, without the little red points or emi- 
nences on the surface of a sore, which denote its healthy 
and healing state,) with matter adhering to its surface, 



15 



and with a thickened edge and base." It will be well 
to keep this short and correct description of a Venereal 
Chancre in mind, as it will serve to compare ulcers of any 
other kind with it. It is not, however, to be supposed 
that every Venereal Chancre will exactly agree with it 
in every respect, for peculiarities of constitution and other 
circumstances have their effect upon the chancre, as well 
as upon sores of any other kind, and will sometimes pre- 
vent its perfect development of character, still there will 
be always enough about a Venereal sore resembling the 
picture of it given by Hunter, to show its true nature, and 
those features which are wanting to make the resemblance 
perfect may often be accounted for. For instance, the 
sore may have commenced in a little laceration or tear- 
ing of the skin, Venereal matter having come in contact 
with it. In this case, it is some time — a week or two — 
before it looks like anything more than a common tear of 
the skin, and when the hardness does form, it forms slow- 
ly; in this case also, the ulcer, instead of being circular 
and deep, is irregular, superficial and broad. Still you 
see it does not heal up by simply washing, as a common 
sore would do. So also, if the person has been foolishly 
dabbling with mercury, — that is to say, has been taking 
enough to inflame the sore, but not to cure the disease — 
this, it is well known, will prevent the formation of its 
true character for a while, but when it is left off, and the 
part merely kept clean, for the sake of watching its pro- 
gress, this characteristic hardness of edge and base, or 



some other Venereal peculiarity will appear, so as to 
enable you to judge safely as to its real nature. Let it. 
however, be remarked, it is not said that a sore upon the 
Genital Organs can in no case possibly be Venereal without 
this peculiar hardness of its edge and base, for exceptions 
do occur rarely. The Chancre has appeared m some rare 
instances after a swelling in the groin had taken place for 
many days. And further, there have been known such 
things as Venereal sores whose edges have been thin, hav- 
ing no hardness at all ; but all these are very rare occur- 
rences, and such would not have been worth while to 
perplex the reader with, were it not for the necessity of 
acknowledging candidly the fact When these deviations 
occur, we also get assistance in forming an opinion from 
our knowledge of the character of each party, the time the 
sore appears after exposure, and any peculiarity of con- 
stitution or circumstances we can become acquainted with. 

This therefore is all that need be said on the distin- 
guishing marks of the Venereal disease, especially as I 
shall refer to the subject again in the last Chapter, (xxv), 
on diseases which resemble Venereal. 

The Mature of Venereal Disease. 
But little need be said on this subject. Venereal dis- 
ease ^in many books called Syphilis) is w r ell known to be 
infectious. It is communicated very much like inocula- 
tion of small pox, only in that case it is done by slightly 
cutting the skin with a lancet and then applying small 



pox matter to the sore, whereas, in Venereal the matter 
is so infectious that it is received without a breach of the 
skin, especially in those parts where this is very thin, as 
on the genitals; it is, however, much more sure to take 
if the skin of these parts should be torn or abraded. It 
is most generally communicated by sexual intercourse, 
though it may be given and taken in a more innocent 
way, such as kissing, or suckling an infant, and in these 
unsuspected ways it has been most disastrous and fatal. 
It is a disease which scarcely ever, perhaps never, wears 
itself out, but, unless cured by art, continues sometimes 
for years, undergoing different forms, until the miserable 
sufferer dies, generally as though he were in a decline. 
Formerly death was more rapid, but the disease seems to 
have become moderated in its intensity, though not in its 
ultimate effect. If, however, mercury has been taken, 
but not in such a way as to cure the disease, the patient 
then may live many years, and the original disorder be- 
come so altered as scarcely to present any symptoms by 
which its original character can be judged of. Further, 
it differs from most other contagious disease, inasmuch as 
they, when they have once occurred, leave the constitu- 
tion protected for ever against their recurrence. The 
small pox, measles, hooping cough, and others do this ; 
and even typhus fever leaves the constitution safe from a 
fresh attack for a long while; but with respect to the Ve- 
nereal disease, this may be cured and taken afresh a hun- 
dred times; and, indeed, may be again taken the next 
moment after being cured, if exposed at such a time. 



The following facts relating to the contagious nature 
of this disease, are not generally known, viz : Syphilis 
or Venereal Disease can only be communicated from one 
person to another during its first stage, ii e., during the 
existence of its first symptom — the Chancre. In its se- 
cond stage it cannot be given or taken by sexual inter- 
course, but, if conception takes place, the child will be 
Syphilitic, being either prematurely born dead and putrid, 
or if alive, covered with Venereal eruptions, &c. &c. In 
its third stage also, it is not contagious, i. e., cannot be 
given or taken, but any offspring would be born scrofu- 
lous and injured for life, if they passed through childhood 

The Symptoms and Progress of Venereal Disease. 

This is a subject worthy of much attention. The pro- 
gress of this disorder is divided into three stages : — the 
Primary Stage, the Secondary Stage, and the Tertiary 
Stage, and each stage is attended with its own peculiar 
symptoms. 

The Primary Stage consists in the Chancre, which has 
already been described : it is the only way in which Syph- 
ilis can first make its appearance, or be imparted from 
one individual to another ; it marks the precise spot where 
the virus or poison was first imbibed or inoculated into 
the skin. Chancre then is the principal or constant symp- 
tom of this stage. The occasional or Accidental Symp- 
toms, which may or may not be present, are Bubo, Phy- 
mosis, Paraphymosis ; they are described at Chapter xv. 

• 15 



The Secondary Stage is that in which the effect of 
constitutional empoison ment first show itself, and hap- 
pens only when the disease has been allowed to take its 
course, or has not been thoroughly cured in its first stage, 
but left in the blood ; hence the symptoms are no longer to 
be looked for in their original seat, the Genital Organs, 
but in distant parts of the body, or over its whole sur- 
face. It is a curious fact, that there are certain parts of 
the body that this disorder attacks in a regular order of 
succession, and it seldom attacks one of these parts before 
the other out of that order ; when, therefore, a Chancre 
has been only healed up, as by an ignorant use of caustic, 
or an ignorant and ineffectual use of mercury, without 
really curing the disease, then, at some period, usually 
before the end of the second month, after laying aside all 
remedies, it will appear again, either in the throat, or 
sometimes the throat and skin together, and this is called 
the constitutional or secondary form of the disease. Then, 
if mercury is again resorted to, but not so as thoroughly 
to cure the disease, the skin and throat may appear to get 
well, but after another period, it will be seen again on 
the skin, sometimes in the same, and sometimes in a dif- 
ferent form of blotch, or scab, or sore, — see Chapters xvi 
and xvii. Thus it may appear and disappear many times 

The Tertiary Stage is that in which the bony system 
is attacked ; its symptoms are, tumors and disease of the 
bones, especially those only covered by skin, as the head. 



wrist, shin, &c, attended with some pain which comes on 
at night only. (See Chapter 



XVI 



The Consequences of Venereal Disease. 
Left to its own course, it is a fatal disease. If partly 
cured, a progressive deterioration of health and strength, 
deformity, impotency, or a diseased off spring, &c. (See 
Chapter xix.) 



CHAPTER XIV. 

On the Remedies in general use for Venereal Disease. 
The mode of employment. 
Their value. 

The remedies used for the cure of Syphilis or Vene- 
real Disease are External and Internal: the External 
remedies consist in Lotions, Poultices, Caustic; — the In- 
ternal are Purgatives, Mercury in different forms, and 
sometimes Opium, Bark, Sarsaparilla, Nitric Acid. 

Lotions. — These are required either as a means of al- 
laying pain and inflammation, or as applications to the 
Chancre or other sore. Thus, a Chancre, on whatever 
part of the penis it may be situated, sometimes becomes 
very painful and angry ; the surrounding skin, as the 
prepuce, or even the whole penis will often in this case 
be similarly affected, sometimes swelling enormously with 
much redness, pain and heat ; in this way, phymosis and 
paraphymosis are induced by the presence of a Chancre. 
Here, just as in Gonorrhoea, cooling lotions are very Le- 
cessary and useful. They are applied by means of a rag 
wet in them and wrapped around the penis, or laid on 
the skin if in any other part, and which rag should be 
repeatedly wetted or soaked, the more heat and inflam- 
mation in the part the more will the rag get hot and dry 
if not attended to; on this depends the utility of Lotions, 



(see Chapter ). Of the Lotions used as application 
to the Chancre or other sore, the Black-Wash is the prin- 
cipal ; in this preparation the black powder or sediment 
which falls to the bottom is the only useful part, the wa- 
tery portion being of no value; to use it properly there- 
fore you must collect the black powder on a little piece 
of lint, which is easily done by holding the vial for a few 
seconds mouth downwards, on a bit of lint in the palm 
of the hand, then applying the black side carefully against 
and in contact with the surface of the sore. This is a 
mercurial wash, and ought to be used, generally, only 
when mercury is taken internally. Other Lotions, how- 
ever, are often useful and even preferable to this ; this is 
the case when the Chancre is free from any hard indura- 
ted edge or base, and only needs urging to heal. These 
Lotions are generally composed of Sugar of Lead or 
White Vitriol, at about three or four times the strength 
of Gonorrhoea Injections. Sometimes a vegetable astrin- 
gent or aromatic is added to them, as Tincture of Myrrh 
or Compound Spirits of Lavender, or a little Laudanum, 
if the sore is painful. 

Poultices are sometimes required for Chancre or Bubo, 
especially when they become very inflamed and irritable. 
Bread and Milk, Flaxseed and Bread, or Slippery Elm, 
form the principal ingredients, and such are called simple 
or plain poultices. They may however be medicated, to 
render them mercurial, or opiate and soothing, as the case 
may require. 



Caustic. — The only substance of this nature at all fit 
for private hands is the Lunar Caustic, lightly run over 
the surface of a Chancre or other sore, every one, two or 
three days ; it is a most excellent and powerful healing 
remedv. When used as an abortive application to Chan- 
cre, the rules fur the Abortive Treatment of Chancre,, to 
avoid risk, must be strictly adhered to. 

Purgatives constitute a very active means of reducing 
inflammation, or a too full or plethoric state of the sys- 
tem. There is much, however, in selecting the proper 
purgative for the particular case. Thus, when the object 
is to act against inflammation, a vegetable, or vegetable 
and saline medicine is the best. When preparatory to a 
course of mercury, a saline purgative with antimony. As 
a mercurial purgative, five grains of calomel in a pill, at 
night, followed by a dose of epsom salts in the morning, 
is the best. 

Mercurial Medicines. — There are many preparations 
of Mercury, each varying to some degree in its influence 
over the constitution and the disease; the following are 
the principal and the most valuable. 

Blue Pill, is a mild and very excellent preparation of 
mercury. The dose is five grains (in a pill) at night, and 
is increased by taking another such pill in the morning, 
or still further by taking two pills, ( 10 grains), at night; 
this is the highest dsfite* It will often purge at first, if it 



does so a little at first, or even very moderately through- 
out the course, there need be no objection to it, rather 
the contrary ; for, where the bowels are not at least na- 
turally open, it becomes necessary to keep thern so by 
taking some additional medicine, as a mild aperient along 
with the dose of mercurial at bed-time. But, if it abso- 
lutely purges, and this effect does not cease as it general- 
ly will alter the first few doses, it is then necessary to 
check it; this is done by having one eighth of a grain 
of opium mixed with each pill. Blue Pill is perhaps 
the safest and best of all the preparations of mercury, in 
ordinary cases. 

But it is one of the most frequently adulterated, and often 
difficult to be obtained pure and in proper proportions. 

Calomel. — This, as is generally known, is a purgative 
preparation of Mercury, and when taken as such should 
always be followed up by a purging draught of Salts, or 
Senna tea, some hours afterward. When taken to affect 
the system, however, this purgative effect is not required, 
and indeed generally subsides after it has been taken for 
a few days; though, it may persist, and then it should 
always be checked by the addition of a little opium, as 
directed for the blue-pill. The dose of Calomel is from 
two to five grains, made into a pill and taken at night 
or night and morning. If it gripes, a quarter or half a 
drop of one of the stomachic essential oils might be add- 
ed to each pill. 



Corrosive Sublimate. — This is a very active prepara- 
tion of Mercury, and should be used only in urgent cases. 
There are forms of Venereal Disease, however, which 
require a very quick effect of Mercury ; when it attacks 
the nose or throat for instance, in some constitutions, it 
spreads so rapidly, that, if we were to wait the slower op- 
eration of the milder mercurials, it would eat away the 
parts before the Mercury could be brought to act upon it ; 
and it should be known, that, when the soft parts cover- 
ing the roof of the mouth or the thin bones of the nose 
are once gone, they do not grow again — they are gone 
forever. It is therefore most desirable to have some re- 
medy that will very quickly put a stop to its progress. 
When this is done, however, this active medicine should 
be laid aside, and the cure completed with a milder and 
safer preparation. It is not a remedy to be relied upon 
for the cure of this disorder, but to check and arrest it 
when the destruction of important parts is threatened, 
and this it will speedily do. An eighth, or at the utmost, 
a quarter of a grain may be taken three or four times a 
day ; but for the manner of taking it more particularly, 
A knowledge of particular care is needed. 

Blue Ointment is another excellent form in which to 
exhibit Mercury, and is preferred by some eminent sur- 
geons, to any other ; but the trouble and inconvenience, 
as well as the soiling of the linen it gives rise to, is an 
objection to its general use. It is sometimes necessary 



as additional to the internal medicine, either to hasten 
Salivation ; or when, as in some of the Secondary forms 
of Syphilis, the internal medicines cannot be alone trusted 
to ; or again, when the stomach will not bear any pre- 
paration of Mercury, this form alone is used. 

When the Blue Ointment is fixed on from one half a 
drachm to a drachm is rubbed into the thigh every night 
and sometimes night and morning. But in the manner 
of using Mercurial Ointment, I must be more particular. 
In the first place, it should be rubbed in by the patient 
himself, but, if from debility or any cause he should not 
be able, then those who rub it on should have their hand 
guarded with a bladder, and the best way to arrange it 
is the following : Get a pig's bladder, and, after being 
steeped in tepid water, turn it inside out ; then soften it 
well with lard or sweet oil, and put it on the hand like a 
glove, tying it round the wrist with a piece of tape. Still 
it is better that a patient rub it himself. Take therefore 
a quarter of the quantity to be used in the hollow of the 
hand and rub it briskly up and down the inside of the 
thigh till it has entered the skin, when the hand will not 
pass so smoothly; then take another quantity, and so on 
till it is all rubbed in. It is common for it to make the 
thigh a little sore, or to bring out a crop of pimples on 
it by rubbing; in this case, change the thigh, and if the 
same thing happen again, take the inside of the arm ; 
any part will do where the skin is thin. It is a good 
thing also to wash the old ointment off now and then 

16 



with soap and water — the skin will take the ointment bet- 
ter for it. The rubbing may be either night or morning. 
Throughout this course of rubbing, wear a pair of flannel 
drawers next the skin, the same pair the whole of the time. 

Fumigating Mercury. — This, like the Corrosive Subli- 
mate, is chiefly valuable in cases of spreading Venereal 
sores particularly of the throat and roof of the mouth, 
and, when these are attacked, it is indeed a valuable 
remedy. Its effect is much more speedily seen than that 
of the Sublimate, but the manner of using it hitherto has 
involved so much trouble and impossibility of privacy, 
that, invaluable as it is, it has seldom been availed of. — 
The preparation used for this purpose is the Red Sulphu- 
ret of Mercury, (Red Cinnabar). — The directions for using 
which have been the following : — Take a red-hot com- 
mon heater, or better, a red-hot brick, and place it upon 
a brick; then throw on this half a drachm of the Red 
Cinnabar, when fumes will instantly arise ; these are di- 
rected to the throat and nose by breathing in the fumes 
through an inverted funnel held over them. In this man- 
ner fumes may be applied once or twice a day. This 
plan, however, will instantly be seen to be quite impossi- 
ble, without betraying for what purpose it is done, and 
therefore the following contrivance, which I call a fumi- 
gating candle, will be esteemed highly. 

Fumigating Candle. — For this contrivance I am in- 
debted to a late work on Venereal Disease by Mr. Colles, 
an eminent Surgeon of Dublin. This plan of fumigating 



by the burning of a candle, is rather hinted at than des- 
cribed, but its real value struck me so immediately, that 
I lost no time in putting it in practice, the result of which 
proved most satisfactory. The plan adopted is to com- 
bine the Cinnabar with wax, and make of this a candle 
of the common size, an inch or two in length, divided by 
a line around it, into four parts. With this, there is 
nothing more to do than to light the candle and to inhale 
the smoke arising from it, this contains the Mercury in 
sublimation, — a penetrating way of applying Mercury to 
parts otherwise of difficult access, and which has a most 
immediate effect. It has also an excellent effect on the 
female genital organs, as well as on the sores which fre- 
quently occur about the fundament. For this purpose 
the candle is placed in a chamber utensil, or night stool, 
over which the patient sits awhile. When the candle is 
burnt down to the line, it is to be blown out. Each can- 
dle an inch or two in length, contains four mercurial fu- 
migations. It is a most convenient and speedy way of 
arresting Venereal in these parts. I have effectually 
stopped the progress of it in twelve hours; and have 
cured excressences and sores about the anus in as many 
days as they had existed months before. 

Opium, — Is a valuable medicine under many circum- 
stances. It is sometimes necessary and extremely useful 
in allaying general irritability, and enabling the system 
to bear the mercurial action with proper calmness. (See 



Bark. — Occasionally, in the treatment of Venereal dis- 
ease especially, it is necessary to support and re-invigo- 
rate the constitution. In cases of great weakness, or 
when a Venereal sore takes on a spreading and unkindly 
character, there is this occasion. Nothing succeeds bet- 
ter in these instances than the Peruvian Bark, — some- 
times alone, but more generally combined with the Car- 
bonate of Ammonia, Opium, &c. 

Sarsaparilla — Is a well known and valuable medicine 
in the treatment of Venereal disease. Not that every case 
of Venereal requires Sarsaparilla — far from it; but there 
are states and conditions of the constitution exceedingly 
unfavorable to Mercury, (the specific remedy), but which, 
by its aid, are rendered capable of bearing Mercury well. 

These are also conditions of the constitution in which 
it is advantageous to give the Sarsaparilla and the Mer- 
cury together, — the constitution bears the Mercury better, 
and the disease is more completely and more certainly 
cured thereby. It will be seen therefore, that the Sarsa- 
parilla is not given to cure Venereal, — it has not the 
power to do this, — but it enables the constitution to bear 
the Mercury which will, and this under such circumstan- 
ces as would render it dangerous to give, or to continue 
that remedy without it. It is true, Venereal symptoms 
will disappear under a course of Sarsaparilla alone, but 
they will return. This fact experience abundantly con- 



firms. Innumerable cases are on record, where, under 
the Sarsaparilla, the symptoms of Venereal in the consti- 
tutions have disappeared, and returned again and again, 
until a course of Mercury has been entered on, when they 
have disappeared for ever. 

Remember, therefore, Sarsaparilla is not given to cure 
Venereal disease, but only to enable the constitution to 
bear that remedy which will ; also, that Sarsaparilla is 
not required in many cases, but only in weak and irritable 
constitutions, or in those in which Mercury is found to 
disagree— rendering the patient feverish and irritable. 

With respect to the manner of taking Sarsaparilla, 
many preparations of it are in use; some of them are 
very troublesome, inconvenient, and expensive; and it 
does not seem to me, that these latter have any great ad- 
vantages above the former. The most simple, conveni- 
ent, and least expensive is the powder; a good large 
tea-spoon full of which, in milk and water, I have found, 
as far as I could see, to answer all the valuable purposes of 
this medicine ; but it may require the other forms, 
according to circumstances. 

Nit?*ic Acid — Is sometimes given and may be very 
useful in Venereal Disease. Not that it has the power 
of curing Syphilis, — that I do not believe it has. But 
sometimes, especially in the secondary stage, after Mer- 



16 



cury has been given in one form or other for the full 
length of time that should ever be necessary — still some of 
the symptoms remain, or return repeatedly; or, when 
sores exist on the body and do not heal up, Mercury hav- 
ing been given to its full extent — and seeming incapable 
of curing the disease ; the truth is, the disease is cured, 
but seme other remedy is wanting to re-invigorate the con- 
stitution, to enable it to throw of that habit of disease 
under which it has long suffered, and for the want of 
which the sore still remains unhealed, or the throat either 
continues superficially sore or it constantly re-appears. 
Under these circumstances Nitric Acid is exceedingly 
Taluable, not but that other remedies might be used, and 
Bark is one, or both may be given together. I happen 
at this moment to have two just such cases, one of Secon- 
dary Syphilis with an ulcer on the leg nearly as large as 
one's hand, the other also Secondary, with superficial 
soreness of the throat constantly re-appearing, both re- 
maining after a full course of Mercury, and both very 
nearly well under the influence of this medicine. Nitric 
Acid is taken in this way : to about a pint of water in a 
jug or bottle add, little by little, some Nitric Acid, taking 
care to taste it after each few drops, so as to make the 
water pleasantly sour, but not painfully so — this quantity 
to be drunk during the day — It may be sweetened. 



And now, a course of Mercury being quite completed, 
and every symptom perfectly removed, many people are 
anxious about the Mercury — to get it out of the system, 
as they call it, but this is quite superfluous. It is far 
better to let the Mercury pass off itself, which it always 
naturally does in a little time. All that is required is 
to take a little more than common care against catching 
cold, and to take a few doses of mild laxative physic. 
It is a fact, that Mercury leaves a person rather more 
susceptible of cold for a week or two, on which account, 
if exposure to wet cold weather could be avoided, it should 
be done ; but, if not, it can safely be encountered by 
clothing suitably and warmly. 



If, however, any remarkable degree of nervous weak- 
ness, or Dyspepsia, or irregularity of bowels should be 
left, these would be best removed by some mild aperient, 
as the common Aloetic or Rhubarb Pill ; or which is 
probably the best thing for this purpose, if you have not 
that, a little piece of Turkey Rhubarb to chew occa- 
sionally. Indeed nothing will be found more useful and 
restorative in a constitution weakened and exhausted from 
any cause, than such restorative aperients. They should 
be taken once a day, immediately after a meal, either 
breakfast, dinner or supper, and in such a dose as just to 



keep the bowels a little more relaxed than natural. Gen- 
erally, however it is seen that a course of Mercury, given 
and conducted in the manner here described, leaves a 
constitution better than it found it. 

But, the treatment and cure of a common, simple case 
of Chancre, having now been shown, it is necessary here 
to state that they will sometimes assume a state of greater 
severity, an inflammatory condition, which demands par- 
ticular attention; this I will proceed to mention : — 

An Inflamed and Irritable Chancre. — This is some 
times seen in a very high degree, and, if Mercury were 
given before it were reduced, it would endanger even the 
very member itself. By the ignorant use, — the abuse, of 
Mercury, in such circumstances, loss of the penis has 
again and again happened, and even the life of the indi- 
vidual. I saw a fatal case of this kind in the N. Y. Hos- 
pital three or four years ago. Naturally and properly, 
pain and inflammation do not belong to a Chancre, and 
if any be present, it is owing to accidental causes. Many 
bring these on by habits of irregularity, excitement, and 
intemperance, and in others they will spring from a full 
and plethoric habit. When a Chancre is highly inflamed, 
the skin around it is of a fiery red color, the parts are 
swollen, and the Chancre very sore and spreading. — 
Never give Mercury in such a state as this. 

The best means of removing this high degree of inflam- 
mation are those made use of in preparing for a course oi 



Mercury, so that here they answer a two-fold purpose. 
Especially is it advantageous, if possible, to rest. In- 
deed, in some cases the consequences are so threatening 
and dangerous that every consideration of secrecy must 
be laid aside, and absolute rest in bed enjoined. More 
generally, however, smart and repeated purging with the 
Antimonial Saline, or Senna and Salts, with low diet 
and partial rest, together, if the patient be full habited, 
with a copious bleeding, will be sufficient. At the same 
time, a soft bandage, constantly wetted with a cooling 
Lotion, and if necessary a Poultice, should be applied, 
But still it may take many days before this inflam- 
matory state is thoroughly subdued, <but however long it 
be, Mercury must not be given until it is removed. 

With respect to the Irritable Chancre, this may be said 
to be the case when it is exquisitely painful, of a dark 
color, and evidently spreading. To this, other applica- 
tions are required. Lint soaked in the Black Wash, or 
in Tincture of Myrrh, or Laudanum, should be applied, 
and over this a Poultice composed of grounds of beer, or 

NOTE ters of a pint. The sugar of lead with 
alittle vinegar should befirst dissolved 

Cooling Lotions. in the Alcohol. 

The Best way to use these is to ap- 

Evaporating Lotion.— A quarter of a ply a fold or two of soft rag, (linen or 

pint of Alcohol, (brandy or other spi- cotton), upon or around the part, and 

rits may be substituted), in three quar- keep this wetted with it. The part 

ters of a pint of water. should be otherwise covered up as lit* 

Lead Lotion.— Sugar of Lead a quar- tie as possible, 
ter of an ounce, soft water one pint,- 

a tea-spoon full of vinegar should be NOTE 
first mixed with the water. 

Evaporating Lead Lotion— Sugar of Poultices. 
Lead a quarter of an ounce, Alcohol a 

quarter of a pint, soft water three quar- Common Poultices, are those made OS 



a plaster of simple Cerate or Lard. Also Bark, Ammonia, 
and Opium should be given freely for a time. But I need 
not here do more than mention them, for in such a case I 
should certainly advise that medical aid be sought. 

There yet seems one remark to make upon the use ol 
Mercury in the cure of Chancre. It relates, especially, 
to when it should be discontinued. I have said that Mer- 
cury never should be commenced when a Chancre is at- 
tended with high inflammatory symptoms ; I now would 
add that it should never be continued, but immediately 
discontinued, whenever such appearances occur in the 
progress of its cure. It generally happens that when a 
Chancre or any Venereal symptom does well with Mer- 
cury, it goes on progressively to improve until the cure is 
perfectly accomplished ; but, if instead of this, after im- 
proving for a time it suddenly changes in its appearance, 
and inflames and spreads, depend upon it Mercury is dis- 
agreeing, and it would be vain and dangerous to expect 



Bread and Milk— or Bread, Flax-seed 
meal and water or milk — or, Ground 
Slippery -Elm Bark. They are made 
just stiff enough to hold together a lit- 
tle, and applied as waim as can he 
home. 

Mercurial Poultice, is the Bread, or 
Bread and Flax-seed meal Poultice 
made up with Black- Wash, instead of 
Milk or Water. Used to spreading 
Chancres. 

Soothing or Opiate Poultice, by ad- 
ding to one of the Poultices half an 
ounce or an ounce of Laudanum, ac- 
cording to its size. 

Grounds of Beer Poultice, — made by 
using grounds of Beer instead of wa- 
ter- 

Carrot Poultice, boil the Carrots weU 



in but little water and smash them. It 
corrects the smell and agrees with many 
bad sores. 

NOTE 

If the Bark alone is given, a tea- 
spoon full of the powder in a glass of 
water or wine and water, is a proper 
dose, and repeated two or three times 
or oftener in the day. Another way of 
taking the bark, especially in unkindly 
spreading sores, is the following: — De- 
coction of Bark, half a pint — Carbonate 
of Ammonia, two scruples— Compound 
Tincture of Bark, six drachms — Tinct 
ure of Opium, one drachm, of which a 
wine glass is a dose, taken every third 
or fourth hour. 



it would re-assume a healing state under the continuance 
of Mercury. Either the Mercury is acting too powerfully 
upon the system, or the Venereal nature of the disease is 
cured, and Mercury is no longer needed : at any rate it is 
disagreeing, and must now be discontinued. 

The Use and Abuse of Caustic. 
The application of Caustic to a Chancre is very com- 
mon ; it is done on the principle of destroying the Chan- 
cre, of destroying its specific action before it had attained 
a certain maturity, by which it can contaminate the sys- 
tem. But this must be considered — as a common practice, 
and in private and ill-informed hands — a very dangerous 
speculation. If we know for fact that the matter secreted 
by a recent Chancre, at any certain early period, is not 
infectious, then indeed it would be highly advantageous 
to cauterize. Now, in the case of Chancre — such an one 
as is defined at the commencement of this Chapter — the 
Venereal action has not only gone so far as to produce a 
pimple or pustule, but this has broken, and if it has ex- 
isted already a few days, an ulcer, secreting virulent and 
contagious matter, is presented. If indeed a part inocu- 
lated with Venereal matter were cauterized or cut out 
immediately, like the part bitten by a mad dog, before it 
had instituted an action at all, it might be then depended 
on - } but this cannot be, (for we cannot tell that a part 
has been affected with Venereal, until it is shown by ul- 
ceration or pimple) ; — or, further, if we have a means of 
judging if there is any period at which the matter of the 



pustule or ulcer is not infectious, then indeed we have a 
ground on which we can rely that the constitution will 
not be afterwards affected, if the Chancre be early and 
perfectly destroyed by Caustic. I would not therefore 
say that in no case whatever is the constitution thus pro- 
tected, but I would ask, who, where the least uncertainty 
existed, would choose to risk his own upon this peradven- 
ture 1 I hold therefore that it is exceedingly speculative 
and unwise, except within certain and restricted circum- 
stances, to depend on Caustic for the cure of Chancre. 
And this too is exactly in accordance with the opinion 
of Sir Astley Cooper. After dissuading from the use of 
Caustic, for other reasons, Sir Astley adds, that if Caustic 
should be used, there being no certainty in this means of 
cure,* a course of Mercury must still be entered on, as if 
no Caustic had been used at all. He also then goes on 
to show the folly of this practice, by relating the conse- 
quence of a case which occurred in a particular friend of 
his, and which I will give in his own words. 

He states, <( A young person with whom I was inti- 
mate, whilst I lived with my old master, got a Chancre, 
which, to use his own expression, he burned out by the 
application of Caustic : I laughed at him for being so 
foolish: the Caustic produced a slough but cured the 
Chancre, and I thought nothing more of the circumstance. 
Some time afterwards, I visited him in the country, and 

* At the time Sir Astley Cooper wrote, Abortive Treatment bad not been di«- 
the rules respecting it9 proper use as an covered. 



asked him how he was ? * Very well, now,' he replied, 

' but I have been in a fine scrape ; I was engaged, when 
I left town, to a young hdy, the nuptials were to have 
been soon celebrated, and the business of life commenced.' 
I involuntarily smiled, but he said, ' Not quite so merry : 
when I got into the country, I had what I conceived at 
the time was only a huskiness of the throat which I had 
caught from cold. My throat becoming more painful, I 
looked into the glass, and perceived that I had a large 
sore on the tonsils, decidedly Syphilitic. You may con- 
ceive how I felt , I wrote to the young lady that I was 
unwell, who, exceedingly hurt at such news, came and 
nursed me while I underwent a course of mercurial treat- 
ment, (she being perfectly unconscious of the cause of 
my complaint), by which means I was quite restored, and 
the marriage ceremony was celebrated.' " The follow- 
ing remarks of Sir Astley are so much to this point that 
I must conclude with them. He then goes on — " It was 
a proper punishment for his folly. The application of 
Caustic to a Chancre does not render a person safe from 
its effects, for, if the sore be a Chancre, the Syphilitic 
poison must have been admitted into the constitution. I 
will tell you what treatment you should pursue; as soon 
as a patient applies to you for this complaint, you should 
ask him if he wishes to be properly cured at once, by a 
simple Mercurial treatment, or have the Chancre cured 
without it, and run the risk of having secondary symp- 
toms occurring at a further period ? His answer will be — 
' for God's sake, give me what is proper now for my cure, 



IT 



without submitting me to the chance of being laid up a 
second time with this complaint.' " 

Notwithstanding these facts and reasons against the 
indiscriminate use of Caustic for the cure of Chancre, 
however, there still are those who practice it. Most of 
such persons, no doubt, are perfectly ignorant of its con- 
sequences ; but there are also those whose opinions are 
entitled to the highest deiference, and who, under certain 
circnmstances, advocate the use of Caustic. Among 
these, an eminent surgeon in France, who has had for 
many years the unusual advantages afforded by a large 
Venereal hospital, has lately recommended it, and has 
pointed out the particular circumstances under which it 
may or may not be had recourse to. The rules and the 
treatment he (M."Ricord) has laid down my own practice 
daily verifies. Indeed, ever since I had the satisfaction 
of witnessing this, treatment, as practiced by himself at 
the Hopital des Veneriens at Paris, I have adopted it 
myself with perfect success. 



CHAPTER XV. 

On Venereal Bubo; 

Phymosts and Paraphymosis ; 

Venereal Warts ; Their Treatment and Cure. 

{Primary Stage ) 

Venereal Bubo. — This is a swelling in one or more of 
the glands of the groin, seldom more than one, and is fre- 
quently observed in connexion with a Chancre. There 
is almost always some degree of pain and stiffness in the 
joint along with Chancre, but if this be only slight, no 
application will be needed. The Mercurial Treatment is 
to proceed exactly as if there was no such feeling or swell- 
ing, and as soon as the constitution is affected, the pain 
will lessen and the swelling gradually decline. But if 
the swelling should go on and pain and throbbing com- 
mences, with inflammatory redness, and perhaps some 
feverishness, then an actual Bubo is setting in, — the use 
of Mercury must be delayed, or, if commenced, omitted, 
while attempts are made to reduce this inflammation. 
These attempts are made by such means as are proper in 
other inflammatory affections, and which have several 
times been mentioned, viz. — rest, purging, and low diet. 
To the part itself any thing which will abate the pain is 
proper. Cooling Lotions are very useful ; but in case 
of Bubo, from Chancre, more energetic measures had bet- 
ter at once be employed. Leeches, half a dozen would 



be applied with very good effect, and followed by a com- 
mon poultice, to ensure a plentiful escape of blood for as 
long as possible afterward. After this the Cooling Lo- 
tion would be proper ; but if not very greatly relieved by 
the Leeching, a Blister of Spanish-flies should be put on 
the same or the next day ; it should be large enough to 
perfectly cover the swollen gland, and might be left on 
about six hours. The dressing required after this is merely 
a little sweet lard spread upon a rag. The blister ought 
to be repeated the next day or so, unless the Bubo was 
much relieved by it, when the Cooling Lotion might be 
trusted to. Also an Opiate pill or Dover's Powderf 
should be taken at night to assuage the pain and obtain 
6leep, is necessary. If, notwithstanding all these means, 
the swelling still goes on to suppurate, that is, to form an 
abscess, it should be opened and treated in the common 
way. Let it only be remembered that Mercury is not to 
be given while matter seems to be forming, nor even after 
it is opened, until the pain and inflammation have sub- 
sided. After this, the mercurial course is to be continued 
as though it had not happened. It should also be known 
that these abscesses are not always found to heal so quick- 
ly as the Chancre which produces them, but will often 
continue for many weeks after the Venereal disease is 
cured. Neither is the hardness or scar, which they are 
very apt to leave, to be regarded in the same light as the 
hardness of a Chancre. In fact, these Bubos seldom go 



on to form an abscess but in constitutions that are not 
exactly healthy, such as those embued with scrofula, or 
affected from derangement of the organs of digestion, and 
therefore require means calculated to correct this state 
and to improve the general health and strength, as Qui- 
nine or Bark, with some strengthening laxative pills, as 
mild aperient preparations kept in the stores, or any of the 
milder Vegetable Pills, or the common Rhubarb or Alo- 
etic Pill of the apothecary stores. As to such things as 
panaceas and the like, this is altogether quackery. En 
deavor to recruit the strength by rational means, as a 
suitable and rather generous diet, the regulation of the 
bowels and the digestive organs by restorative aperient 
means, and adding to these a moderate share of patience, 
nothing need be feared, — time will remove the remaining 
hardness, especially if assisted by any of the preparations 
mentioned 

Inflammatory Swelling of the Prepuce, — Phymosis, 
Paraphymosis. — If a Chancre becomes inflamed and irri- 
table from any cause, it is likely to induce a swelling oi 
the foreskin to such an extent as to prevent its being 
pushed back over the head of the penis, or if pushed back, 
it cannot be drawn forward again. The former of these 
cases is called a Phymosis, the latter, a Paraphymosis. 
Both these states are attended with disagreeable conse- 
quences. In the first, the sore or Chancre cannot be kept 
clean, nor can the discharge attending it escape it there- 



17 



fore becomes irritating and thus adds to the inflammation 
of the parts ; and in the other, the penis itself being swol- 
len, the foreskin acts the part of a tight ligature behind 
the head of the penis, preventing the return of the blood 
from it, on which account it swells still more, looks pur- 
ple or blackish, and not unfrequently, mortifies and comes 
off. It is therefore particularly necessary to point out 
what to do in each of these cases. In the first place, 
then, never begin with Mercury when the foreskin or 
head of the penis is thus swollen or inflamed ; if it has 
been commenced, and these should happen to come on, 
leave it off. I have often said already, never give Mer- 
cury in any case of high inflammatory local disease. This 
is the principle to act on, for it might happen that the 
foreskin did not admit of pushing back, and yet no high 
inflammatory symptoms be present, — no high degree of 
redness, nor excessive pain, nor feverish complaint; in 
this case the Mercury should not be discontinued, for, as 
it proceeds to exert its benign effect, the Chancre beneath 
the foreskin will heal, and a natural condition return. 

But the particular treatment of this case consists in 
local management. One of the first things is to wash 
away the matter that continually forms beneath the fore 
skin, and to keep the Chancre clean. For this purpose 
you must procure a common Syringe. Warm water, or 
soap and water, will answer one good purpose — the re- 
moval of irritating humors, and will also sooth the parts. 
It can scarcely be used too thoroughly. Throw up the 



water with sufficient force to distend the skin, and hold 
it in a little while. In short, do it in any way which you 
may suppose suited to wash away the matter. It should 
be repeated night and morning for the sake of cleansing, 
but if its soothing effect should also seem to benefit, it may 
be repeated oftener. 

But, beside the cleansing effect of warm water, a heal- 
ing one may be superadded. Nothing in general answers 
this purpose so well as the Black Wash. It may be 
used warm if convenient, but this is not essential. As a 
healing, cooling thing, the Lead Lotion is found an ex- 
cellent one, while the other Healing Lotions employed, 
a little weakened, are valuable when any kind of gentie 
stimulant is required. 

At the same time, and especially when the inflamma- 
tory redness is considerable, Cooling Lotions or poultice 
should be applied, wetting a strip of linen with them and 
rolling it round the penis. Or even an Opiate Poultice 
may be advisable. Of course rest, purging, and low 
diet are of great importance. It is a good thing to keep 
the penis from hanging down if possible. 

With respect to the treatment of the other case — the 
foreskin pushed back and remaining fixed — the same ge- 
neral plan which has just been pointed out is equally ap- 
plicable, with the addition, however, of the means adopted 
to bring the foreskin forward again ; but these, having 



been already given for this case in Chapter iv, they can 
be referred to. I must also further add, that in this case, 
being much more dangerous than the former, and, especi- 
ally, as it now and then requires a little incision of the 
skin to liberate and relieve the head of the penis, I would 
always recommend that a surgeon be consulted. 

Venereal Warts. — These sometimes follow after Chan- 
cre, as well as after Gonorrhcea, and are called Venereal, 
though they frequently have nothing of Venereal in their 
nature. It is a curious thing, however, that they some- 
times secrete a humor which communicates the same to 
others. Thus, persons having them have married, and 
after a time the wife has had a similar production. And 
these sometimes increase to a great extent in women, — 
they have been known to occupy a considerable space in 
the female passage, giving rise to much confusion and 
inconvenience. 



CHAPTER XVI. 
On Venereal Soke Throat, — Its Treatment and Cure. 

{Secondary, or Constitutional Stage). 

It has been observed that Chancre is the form of the 
disease in which Venereal first appears, and is therefore 
called the primary form ; and that when a Chancre is 
only healed and the disorder not eradicated from the con- 
stitution, in a certain time, it appears again, not however 
as at first, on the organs of generation, but in some other 
part of the body, but they far more frequently first appear 
in the throat or on the skin than any other. 

In ordinary cases there is but little pain attending the 
accession of Venereal sore throat A person perhaps 
feels a little huskiness, which he may attribute to catch- 
ing cold, but this increasing, he is led to examine it in the 
glass, when he is surprised to see an ulcer there. The 
most frequent situation of this ulcer is the tonsil glands. 
These are two roundish bodies on each side of the back 
part of the mouth, between that curtain-like fold which 
is suspended from the roof. It will be observed that this 
divides as it descends, and at the bottom, between this di- 
vision, the tonsil glands are situated. Now, on one or 
both of these, which are always swollen and red-looking, 
an ulcer will be seen. It looks as if a part of its sub- 
stance had been dug out — the edges overhanging — the 



ulcer also looking foul, with a yellowish thick matter 
tightly adhering to it. There is generally some pain felt, 
particularly on swallowing the spittle, and also running 
upwards towards the ear, and sometimes down the neck 
even to the shoulders. This is a true picture of a genu- 
ine Venereal ulcer in the throat; it may however differ 
materially and yet be Venereal. But an ulcer in the 
throat ever so exactly corresponding with this picture, 
must not, on account of its appearance alone, be called 
Venereal, — it cannot safely and certainly be called so, 
unless its history be traced to some absolute prior Vene- 
real affection. 

With regard to the treatment of Venereal sore throat, 
nothing more can be said than has been directed for the 
cure of Chancre, except that the Mercury should be con- 
tinued some weeks longer. The same preparation for 
a mercurial course is necessary, as well as the same oc- 
casion to discontinue it in the event of high inflammatory 
symptoms and appearances. In general the action of 
Mercury should be kept up for eight or nine weeks, in 
Venereal sore throat. If any one should be induced to 
make it shorter, in consequence of the kindly healing of 
the sore, in all probability, after a few weeks, it would 
return, perhaps in the same, or perhaps, in the other ton- 
sil gland, and looking much as it did at first. 

But it should also here be stated, that after the disorder 
has been perfectly cured, a pain on swallowing, accom- 



panied with a slight degree of inflammation, is very apt to 
occur again on slight occasions, to the great but ground- 
less alarm of the patient. In this case nothing more than 
a slight inflammatory redness is to be discovered — no 
Venereal ulcer. This is merely a nervous affection, and 
can only be explained on the well known fact that ner- 
vous pain is very easily re-produced in parts that have 
been once the seat of ulceration or disorder. 

Further, a feeling of this kind is often complained of 
in connexion with some derangement of the organs of 
digestion, or irregularity of the bowels, for which some 
restorative laxative should be taken in a regular manner, 
and persevered in until a healthy condition of the diges- 
tive organs is established. Washing and well rubbing 
the throat with cold water is also found to be beneficial. 
But the practical use of this remark, is, to avoid the repe- 
tition of the use of Mercury in such a case, and to relieve 
the mind of the harrassing apprehension of remaining 
Venereal disease. 

Another thing to be further apprised of, is, that al- 
though the Venereal ulcer in the throat is generally situ- 
ated on the tonsils where it can be seen immediately, it 
is sometimes situated in parts where it cannot be seen so 
easily, and consequently may avoid detection. Venereal 
ulcers situated in these obscurer parts shall therefore next 
be mentioned, and the means of bringing them into view 
described. 



1st. An ulcer on the upper and hack part of the throaty 
concealed by a curtain-like fold suspended from the roof 
— A person who has had Venereal disease, for instance, 
complains of a pain whenever he attempts to swallow; 
it may even be so constant as to deprive him of sleep, 
and yet, upon inspection, no ulcer, nor even appearance 
of inflammation can be seen. But now we should re- 
member there are places where it may lie concealed, and 
the first of these to be supected is behind the curtain of 
the mouth. To bring this into view, therefore, direct 
the person to draw in his breath deeply, when the cur- 
tain will draw up, and we may see at least a part of an 
ulcer on the upper and back part of the throat. A still 
better view of this may be obtained by pressing down 
the tongue and lifting up the middle point of the curtain 
with a curved probe, or with any other convenient arti- 
cle. An ulcer here is generally circular, deep, and foul, 
the surrounding inflammation extending a very little way 
beyond its margin. 

In addition to the internal use of Mercury, as directed 
for Chancre, these ulcerations require a peculiar, local, 
and decided mode of treatment. I would however men- 
tion, once for all, that these local remedies would not be 
safe in the hands of private individuals, and I shall there- 
fore barely mention them. My principal object in ma- 
king these remarks is merely to apprise the sufferer of 
the nature of these affections, in order that he may know 
when and how to obtain efficient aid before it is too late. 



The principal danger of these maladies depends not so 
much upon their nature as their obscurity, and the conse- 
quent delay of the proper means of cure. Under these 
circumstances the disease is apt to spread, and some of the 
parts within this neighborhood are next to vital — the top of 
the windpipe for instance. It should be also known that 
the process of ulceration is to destroy, and that parts de- 
stroyed by this disease are never re-produced. 



One of the best local applications to sores of this kind is 
the caustic called Butter of Antimony. It gives pain, but 
this is of short duration, and is soon followed with ease in 
swallowing and sleep at night. This is a very active caus- 
tic application. When used for venereal ulcers of the 
throat, a little lint rolled pretty firmly in the eye of a sil- 
ver probe, is to be dipt into the liquid, and this gently 
pressed upon the surface of the ulcer. Care must be taken 
that none fall upon the surrounding parts. In cauterising 
ulcers upon the roof of the mouth, the edges only must be 
touched and not the centre of the sore, for here the soft 
parts are so thin that an ulcer soon exposes the bone. 
Milder applications are sometimes used, as solution of 
nitrate of silver, tincture ofbenzoes, &c. 



2d. An Ulcer on the back of the throat below the level of 
the tongue. — When we do not discover a sore above, we 
should see if there is one below the level of the root of 
the tongue. If there be an ulcer here it is desirable 



18 



to ascertain it, for in this place it is very apt to creep 
lower still and fix on the top of the wind-pipe, which, of 
all places is most dangerous and fatal. An ulcer low 
down in the back of the throat has this peculiarity — it is 
shallow at its upper edge, but deep at its lower part. A 
pretty sure sign of an ulcer in such a place is, that on 
eating, a morsel seems to stop at a certain point, and can 
only be got rid of by taking a sip of any liquid. 

An ulcer discovered in this situation is best treated by 
the application of the Muriate of Antimony, as before 
described. 

3d. An ulcer situated at the lower part of the curtain- 
like fold of the mouth, just as it terminates in the base of 
the tongue. — An ulcer in this place is attended with pain 
on swallowing, as well as pain shooting upon one side 
of the head and face ; it is also complained of on pressing 
down the tongue. This sore is exquisitely sensible, and 
this sensibility should be destroyed by touching it with the 
Muriate of Antimony, or a strong solution of Lunar Caustic. 

4th. — An ulcer situated high up the roof of the mouth, 
behind the curtain, and which cannot be brought into view 
by any means. — An ulcer is judged to be situated in this 
part by the voice, which is nasal, and there is not only 
pain on swallowing, but the person is teased with the 
frequent desire to draw down the mucus from the nose, 
which also when coughed up is found tinged with blood. 



This case too is one which requires the application of 
some Caustic to allay its extreme sensibility before the 
slower and curative operation of Mercury can exert its 
influence upon it. It is done by a piece of lint dipped in 
a strong solution of Caustic, and well secured upon the eye 
of a probe, which is bent up or curved so as to reach it 

The sores I have now described are so many specimens 
of well-marked Venereal ulcers. But it should be known 
that Venereal ulcerations in the throat are occasionally 
seen to differ greatly from these appearances. They are 
made to do so partly from the improper use of Mercury, 
and partly from the influence which a scrofulous consti- 
tution has upon them. To describe all these differences 
would be almost impossible, as well as useless. The fact 
itself, however, should be known. 

But there is one particular state of the throat which it 
may be as well to mention, being of frequent occurrence, 
which gives rise to much perplexing and unfounded ap- 
prehensions. It has nothing at all to do with Venereal, 
for it frequently occurs in those who never had this mal- 
ady, yet it happens to occur in those who have once had 
the disorder, it is difficult to divest their minds of the fear 
that it is a remainder of it. This state consists of a thin 
covering of a whitish or yellowish hardened mucus on 
the back part of the throat. It is more troublesome and 
harder in the morning than during the day, for then much 
of it will be removed by swallowing and talking. Ai- 



though this is a very obstinate affection, and will some- 
times coniinue to give trouble for years, and not improve 
by any means employed. Yet it is not dangerous — it is 
only troublesome. To ascertain the present disease, it is 
only necessary to rub off a portion of the mucus with a 
piece of lint wrapped round a probe and we shall see 
there is no ulceration, — the parts beneath only look a 
little rougher and dryer than natural. It is sometimes 
benefitted by gargling with sea water, or by sea-bathing. 

Further, there are certain affections of the throat and 
mouth, which sometimes appear after the perfect cure of 
the Venereal disease by Mercury, and which seem to be 
the effect of Mercury ; and what is very singular is, these 
affections never appear when Mercury is given for any 
other malady ; it seems therefore that they are the com- 
bined effect of Mercury, with the former, but now cured, 
Venereal disorder. It would only be to harass the mind 
to say any thing more than merely mention that such 
may happen. 

With respect to Venereal ulcers in the mouth, it is only 
necssary to say that these may appear on the gums as 
well as on the tongue, and on any part of it. These, 
however require no other treatment than a Mercuria. 
course as recommended for Chancre, together .with such 
local applications as have been mentioned, the necessitY 
of employing which, however, being determined by tL_,. 
rapidity or pain demanding a more immediate relief than 
the slower process of Salivation w T ould a ff" rd 



CHAPTER XVII 

On "Venereal Eruptions, or Blotches on the skm.- 
Their Treatment and Cure. 

{Secondary Constitutional Stage.) 

This constitutional or secondary form of Venereal dis- 
ease I have placed in order after Venereal sore throat, 
but it should be remarked that the two very often appeal 
together, and sometimes the eruptions will first appear in 
order, or without the sore throat at all. 

The word blotches is very often used to express Vene- 
real disease affecting the skin ; but it is very far from 
being confined to blotches or copper colored spots ; indeed 
there is scarcely a single order of cutaneous eruptions 
which Venereal does not now and then assume, so that 
it may appear in the form of specks, blotches, pimples, 
vesicles, pustules, tumors, branny spots or patches, scab- 
by sores or open ulceration. It would be quite impossi- 
ble to give a particular and distinct description of all the 
various forms of Venereal disease upon the skin. In fact 
there is nothing in the appearance of these eruptions, con- 
sidered in themselves, that can in any safe and certain 
manner establish the opinion that they are Venereal. This 
the most distinguished surgeons are aware of, and in or- 
der to form their judgement upon any given case, they 

* 18 



always have recourse to the history of the disease, consi- 
dering especially the manner in which Mercury has been 
given, and observing also, whether there are any other 
symptoms connected with them of a suspicious or Vene- 
real character. This, therefore, shall be the manner in 
which I will now endeavor to assist my reader in judging 
of his own or any other case. 

But first, it should be known of these eruptions, that, 
although there is great variety in the appearance of them, 
there are certain forms which much more frequently ap- 
pear than others, and there are certain changes which all 
are more or less disposed to undergo. Perhaps the most 
frequent form is a branny or scaly appearance, occurring 
especially in the palm of their hands, or on the head, or 
the margin of the hair. The next to this in frequency 
may be that of copper-colored blotches, which in time 
become scabby, particularly about the forehead. A rash, 
not unlike the measles, is another not uncommon form — 
covering sometimes only a small part, and at others the 
whole surface of the limbs and body. Pimples and little 
pustules containing matter might next be mentioned. 

Venereal eruptions also are disposed to change in their 
appearance. If they are allowed to subside spontaneous- 
ly, which they generally do after some few weeks, at least 
to some degree, the form in which they re-appear is pretty 
much the same; but if Mercury has been given, (not 
however in a way to effect a cure, its re-appearance is 



most frequently in some different form. For instance, if 
the eruption had been in little pimples, it may now be in 
little pustules containing matter; or if it had been in 
branny scales, it may be next in larger patches or in scabs 
Further, there is a remarkable tendency in all Venereal 
eruptions to become scabby and incrusted ; — thus pimples 
and scales at length assume a scabby covering, and those 
which begin in pustules, and naturally terminate in scabs, 
become exceedingly thick and crusty, forming elevations 
on the skin. 

There is a period at which Venereal eruptions natural- 
ly and spontaneously abate or disappear and re-appear. 
This is very apt to deceive, as to the efficacy of useless 
medicines. Frequently such things as panaceas, or other 
foolish things are taken, and if the disorder happens to 
abate, it is supposed that these are curing it; this, how- 
ever, at length turns out to be complete deception. 

The re-appearance of Venereal eruption, also, as well 
as its first appearance, is always preceded, more or less, 
with some general feelings of disorder ; as head-ache, or 
pain in the bones and lassitude, which are relieved as the 
eruption advances. 

On the going off and perfect cure of Venereal eruption 
by Mercury, it frequently happens that some spots of dis- 
coloration of the skin remain for a long while after the 
absolute cure of the disease This, time only will remove ; 



any further use of Mercury on this account, or any appli- 
cations to them would be useless, and indeed, far worse 
than useless. 

Before the means of cure are entered on, it still remains 
to say a word or two to assist in ascertaining whether an 
eruption really be Venereal or not. 

Many persons both from far and near, come to me with 
one single question. After stating a few preliminaries, 
and showing some specimen of disease, they ask, "Is this 
Venereal ?" To this I frequently reply, " I cannot say this 
moment, but I will soon find out." I then begin to enter 
on the history of the symptoms, and see to what I can 
fairly trace them back. Perhaps it will come out, as it 
often does, that the person never had Venereal at all, but 
only Gonorrhoea, (vulgarly called Clap) — this of course 
is satisfactory, and I say at once, "It is not!" Gonor- 
rhoea never causes eruptions of this kind ; the remedies 
which are often used in this complaint may produce erup- 
tions, which however are very different. 

But supposing it be fairly traced to a Venereal affec- 
tion and that Mercury has been taken, the next enquiry is 
as to the manner in which it had been taken ; and here 
I generally find a satisfactory answer. Few, very few, 
indeed I may say none of those who come to me with 
secondary forms of Venereal disease, are found to have 
taken Mercury properly. 



Tins is a very universal fault. The most part have 
never taken it so as to affect the gums at all, — others 
have left it off the moment the first tenderness was felt, 
and those in whom it brought about a salutary spitting, 
continued it for a period well known to be too short to 
effect a perfect cure. 

But, suppose again we cannot be so well assured that 
Mercury was taken ineffectually. In this case we natu- 
rally look with more anxiety for any other symptom. 
Now, the one most frequently occurring in connexion with 
Venereal disorder is sore throat, and if this appears at the 
same time and in a way resembling what has been said 
upon this subject in another place, it will afford a strong 
corroboration of the fact. 

The time, too, which may have elapsed from the period 
of taking Mercury for its cure, is another thing which 
throws some light upon the subject. Although there is 
a general interval between the apparent cure of Chancre 
or a Venereal eruption, and the re-appearance of the dis- 
ease, which may be stated to be from eight to ten or 
twelve weeks more, yet, if an interval of six months, for 
instance should occur from the last appearance of Venereal 
symptoms, I should consider this longer interval as afford- 
ing a stong presumption of the perfect cure of the com- 
plaint whatever eruption or circumstance should follow 

After these remarks, then, it is presumed, no person 



would conclude of any disorder he might have upon his 
skin, or face, that it was of a Venereal nature, without 
considering — first, that he must really have been once the 
subject of this malady ;— next, that the course of Mercu- 
ry he had undergone had not been satisfactory, — and last, 
that the interval between the former disorder and the pre- 
sent symptoms, is one of at least six or eight weeks. 

And now, on the subject of the treatment of Venereal 
eruptions, I can really say nothing in addition to what has 
been said on the cure of Chancre, only that, as in the case 
of sore throat, it is to continue two or three weeks longer 
than in the cure of Chancre. A course of two months at 
least should be taken. There is one hint however I will 
give upon this subject. Do not allow the early and kindly 
disappearing of the eruption to lull you into a false secu- 
rity that the disease is cured, so as to induce you to shor- 
ten the course on this account. There is no form of Ve- 
nereal which so quickly yields to the influence of Mercury 
as some of these eruptions. 



CHAPTER XVIII. 

On Venereal in the Bones ; — Nodes, — Disease in the 
Nose, — the Palate fyc. 

{Tertiary Constitutional Stage). 

This disorder does not usually appear in the bones until 
after it has attacked the throat or skin ; but it does some 
times occur soon after the healing of a Chancre, without 
a previous affection of the throat. 

The parts more frequently the seat of this disease are 
the hard portions of the long bones — those particularly 
which are least covered with flesh, as the shins, the bones 
of the fore-arm and the forhead. The softer parts or ex- 
tremities of the long bones, as well as the small ones of 
the hands and feet, are but rarely affected, and then only 
when the disease has continued a long time and the con- 
stitution has been distressed with various ineffectual re- 
medies and attempts to cure it. Our business therefore 
will be to consider it chiefly in its earlier and more com- 
mon form — that of lumps or tumors on the hard bones, 
called nodes. 

Venereal Nodes. 
These are attended, generally, with severe pain — re- 
markable for coming on in the evening and continuing 



until an early hour in the morning, say till 3 or 4 o'clock, 
when it abates considerably so as scarcely to be com- 
plained of in the day ; as evening approaches however, 
it returns to its accustomed or increased severity. But it 
should be also known, lest in any case its absence should 
mislead in judging of its nature, that, now and then, the 
formation of a Venereal Node is attended with but little 
pain; also in some instances, a Node will commence with 
a feeling of softness in the swelling, with much pain, but 
which, after a few days, becomes hard with scarcely any 
pain. 

Nodes are disposed to suppuration — that is, to form 
into an abscess and break ; but this they proceed to very 
slowly. A Node once formed will often remain for many 
months without the least change — -no discoloration of the 
skin or feeling of matter ; more frequently however, they 
slowly proceed to suppurate. When Nodes proceed thus 
far, the bone itself partakes of the disease, and is a long 
while in getting well. 

I should also observe that a Node, at first, is nothing 
more than an inflammatory state of the membrane which 
covers the bone, causing the effusion of a little fluid. 

The Treatment of Venereal Nodes differs in no wise 
from that of other Venereal affections. The Mercurial 
course however should be continued longer. The con- 
stitution, also, in this form of the disease, is frequently 
found to be reduced, and to need assistance. 



When a Venereal Node is cured, the swelling and hard- 
ness generally disappears ; but on the contrary sometimes 
the swelling will remain after the disease is perfectly ex- 
tinguish, — to be removed only by slow degrees, or even 
not at all. 

Thus the cure of Venereal disorder in the bones con- 
sists in continuing a course of Mercury for a longer pe- 
riod, frequently in conjunction with Sarsaparilla, and in 
means adapted for the more immediate relief of pain and 
suffering — repeated blistering. The Mercurial course 
must not be less than two months. 

Rheumatic Pains, or those occasioned by the improper 
use of Mercury must carefully be distinguished from Ve- 
nereal. Those who have been affected once with this 
complaint are very apt to fear that any pains they after- 
wards may have must be Venereal. They are further 
led to this conclusion by remembering their former pains 
came on at night. But, although Venereal pains are re- 
markable for their severity at night, this is not confined 
to Venereal. Rheumatic and other nervous pains are 
generally worse at night than in the day ; a better rule 
to judge by is the situation of the pain. A Venereal 
sufferer will direct you to the middle of the bones, as the 
shin or fore-arm; or to some particular spot on the head 
or forehead, and if you gently press your hand along the 
part a roundish swelling will be felt, generally hard and 
painful to the touch, while those who have Rheumatic or 



19 



Mercurial pains, complain of pain all over; especially 
about the chest and arms and down the legs and joints 
These are not Venereal. Such patients get better in the 
summer. They should be directed to live temperate!} 
and wear warm clothing. The Compound Sarsaparilla 
is valuable in such cases. Dover's Powder at bed-time 
also will afford relief. 

Venereal in the Nose and Palate. 
The hones of the JYose and those which form the roof 
of the Mouth, also merit particular notice here. I might 
have included what I have to say on this subject in the 
Chapter on Venereal Sore Throat, for the disease in these 
bones often begins with a sore on the soft parts covering 
the roof of the mouth ; but as it sometimes commences 
also with little scabby pustules which appear above the 
angle of the nose and upper lip and cheek, and sometimes 
on the membrane lining the bones themselves, it comes 
better in this place. 

The sores in a Venereal affection of the throat most 
generally appear upon the tonsil glands, but they are 
sometimes seen upon the roof of the mouth, and those 
beginning on the tonsils may spread upwards to this part 
It is important therefore to watch these sores, particular- 
ly w T hen on the roof of the mouth, for if they spread, the 
soft part here being very thin, the bone is soon exposed 
and so diseased as to form an artificial opening between 
the nose and mouth. This is always a very serious thing, 



for the voice is rendered nasal by it, and if it be of any 
size, a portion of the food on eating is pressed through 
it upon the face. 

The treatment of an ulcer in the roof of the mouth does 
nut differ from one on the tonsils, except it should become 
inflamed or spreading. Venereal sores wherever seated, 
so long as nothing accidentally occurs to make them 
otherwise, are very slow in spreading and are attended 
with very little pain or surrounded redness; whenever 
any thing of this kind happens, depend upon it there is 
something wrong. 

Generally, when a Venereal ulcer in the throat is do- 
ing well, soon after the commencement of Mercury, the 
sore w T ill begin to improve, that is, from looking foul and 
covered with a yellowish matter, it will become cleaner, 
and little elevated points of redness will be seen upon 
it;— these are healthy granulations, and the surest pre- 
sage of its cure. And if this favorable change should not 
occur before, it is sure to happen as soon as the constitu- 
tion is fully under the influence of the remedy — shown 
by the swelling of the gums and spitting. A Venereal 
ulcer in the throat therefore should be treated exactly as 
a Chancre, and so long as it does not get worse, this 
treatment should be pursued in the confidential expecta- 
tion of amendment as soon as the Mercury is brought to 
act upon the gums and salivary glands. 

But if. instead of this, a Venereal sore throat is going 



wrong and threatens to involve the bones, there are three 
things which should be considered before we can safely 
determine what to do ; — these are, whether it is an inflam- 
matory effect of Mercury, instead of the proper one ; — or 
whether it is a more than usual rapid and spreading Ve- 
nereal sore, requiring a quicker effect of Mercury ; — or 
whether, its Venereal nature being cured, it is not now a 
Mercurial, instead of a Venereal sore. 

An inflammatory sore throat, the effect of Mercury, I 
have already spoken of, elsewhere. In this case, how- 
ever, there was no previous sore, but little superficial 
whitish spots, like thrush, appearing upon inflamed and 
reddened parts. Here, on the contrary, a sore is first ob- 
served, and this, from being very little painful, and hav- 
ing scarcely any redness around it, suddenly becomes 
exceedingly painful, with high inflammatory symptoms 
may fairly be attributed to the Mercury, and we therefore 
discontinue it, at the same time the usual means for aba- 
ting inflammation should be adopted — purging, low diet, 
and rest. If any other remedies were required these would 
be, bleeding and antimonial purges, for which see dire- 
ctinos when the inflammation has abated, the Mercury 
should be resumed in smaller doses, but increased as might 
seem necessary. 

A rapidly spreading Venereal sore Throat is a very 
serious thing. I have stated that this is not the natural 






touioc of lb \s disease, aiid when il happens it implies the 
existence of something- very wrong. 

The cau^e most frequently observed in cases of this 
kind U a disordered or weakened state of constitution, 
generally rendered so by habits of irregularity, or an un- 
successful and injudicious use of Mercury, The previous 
treatment therefore should be a subject of consideration, 
and if Mercury has been taken, it should be ascertained, 
as near as can be, to what extent. If, upon enquiry, it 
should seem that the spreading character of these sores 
commenced while under the free use of Mercury, it should 
be discontinued, at least, for a time; or, if Mercury 
should not have been commenced, it should now be en- 
tered on, and in such a way as to bring the constitution 
within its influence in the shortest time. But in every 
case the state of the constitution will demand particular 
attention, whether it be with a view of recruiting from 
the effects of irregularities or of Mercury, or, with a 
view of enabling it to bear that quick and decided in- 
fluence of this medicine which may now be meditated. — 
Here then we are accustomed to look to the Sarsaparilla 
with much confidence and pleasure. 

The Sarsaparilla is a medicine peculiarly adapted to 
these cases, inasmuch as it has the following three dis- 
tinct effects ; — it is the best medicine that can be taken 
to renovate a constitution, depraved and weakened from 
any cause, especially from Mercury; it has also the 

• 19 



power of arresting the progress of Venereal disease, 
though not of curing it ; — and it has the peculiar effect 
of enabling the constitution to bear that quick effect and 
quantity of Mercury which it could not bear without it. 
In every case of Venereal sore throat, which did not 
seem to be doing well, whether it was deemed expedient 
to increase the dose of Mercury, or to diminish it, or to 
delay its use, I should always advise that Sarsaparilla be 
immediately commenced with. As to the best or most 
convenient form to take it, this may be seen at Note 
The form I have generally used, and with the happiest 
effect, but without knowing that it is better than any 
other, is the Compound Decoction. The Bark, with 
Ammonia, or with Nitric Acid, as mentioned already, 
is also an admirable medicine in these cases. It may be 
given in conjunction with, or without the Sarsaparilla. 

I have at this moment a remarkable and most gratify- 
ing instance of the combined effects of the Sarsaparilla 
and Bark, now under my care. This gentleman came to 
me from the hands of one of the advertising persons of 
our city six days ago. He tells me that when he first 
went to this person he had only a little sore upon the 
yard, (on the site of which, there is at present a considera- 
ble degree of hardness,) for which he gave him drops 
and pills. However, six days ago his throat was in a 
state of deep, ragged, foul and spreading ulceration. In- 
deed the tonsil glands were entirely eaten away, there 



being nothing of them left but their swollen edges. It 
was so far unfortunate that the disease had principally 
fallen upon these glands. He was also pale and emaci- 
ated, and as he said, exceedingly weak and alarmed. In 
this case it was not easy to say with confidence whether 
it was the effect of Mercury, ignorantly given, or of the 
disease, upon an irritable and exhausted constitution. — 
However, I determined to bring him, as quickly as pos- 
sible, under the full influence of Mercury, and, at the 
same time, to give him all the support I could demand. 
With this view I began with the Compound Decoction 
of Sarsaparilla, of which he took a quart a day. After 
two days, I found no change for the better, but was con- 
fident the disease had not increased. I then directed, in 
addition to the Sarsaparilla, the following mixture. Pe» 
ruvian Bark in powder, six drachms, — Compound Tinc- 
ture of Bark, six drachms, — Nitric Acid, one drachm, — 
Tincture of Opium, one drachm, Decoction of Bark, 
enough to make a half pint bottle of mixture, of which 
he was to take the sixth part, three times, and, if he 
could, four times a day. In two days more, making the 
fourth, I thought I saw a little improvement in the throat ; 
but, what was to me a source of satisfaction, the gums 
were now affected by Mercury, with an increased flow of 
spittle. The Mercury was now omited. This morning, 
being now the sixth day, he came a different person — he 
walked with a firmer step, and with a countenance of one 
conscious of an escape from misery far more dreaded 
than death; — he said, expressively, I am better, — I am 



safe. The ulcerations in the throat wtic now totally 
changed; they had lost their foul appearance, and were 
studded with little elavated points of redness, and which, 
in fact, could only be produced by re-producing life and 
health. Thus in six days we see a constitution reduced 
to a deplorable condition, not only brought to bear the 
full and happiest effect of Mercury, but so recruited and 
sustained, as absolutely to commence the healing process ; 
and this, totally and altogether the effect of the Sarsa- 
parilla and the Bark. Nor will I allow, in any one re- 
spect, that this case should be supposed to be exaggerated, 
for I have it in my power to afford the fullest evidence of 
its correct detail, This gentleman (trusting that I would 
not indiscreetly expose his case to every one) has given me 
permission to refer any one I choose to him, and whom he 
will permit to inspect his throat and to acquaint himself 
with any facts concerning it. But this is no new thing ; 
similar instances are continually occuring to me. 

It would therefore seem that the Sarsapanlla, alone, or, 
in more deplorable conditions, the Sarsaparilla conjoined 
with Peruvian Bark, affords the means, either of recruit- 
ing almost immediately a constitution sinking beneath the 
abuse of Mercury, or of propping up its powers in such a 
manner as to enable it to bear the full effect of Mercury 
necessary to put an instant stop to the ravages of Vene- 
real in the throat. 

Respecting the form of Mercury to be used in such a 



case as this, there are some more suitable than others. la 
the case just related, I used mercury with guaiacum, &c 
quickened by the aid of the Blue Ointment, nightly rub* 
bed into the thigh ; but if this had not shown its due ef- 
fect upon the mouth within the time it did, or, if it had 
been a case in which every thing depended on this quick 
effect, I should have used the corrosive stiblimate, as di- 
rected previously; and perhaps have aided this by local 
remedies, next to be explained. 

Local applications to Venereal ulcers in the throat are 
adapted to two objects; — the one temporarily to check 
their rapidity and to give relief to present pain, — the other 
to remove them permanently by curing the disease itself. 
Those adapted to the first of these intentions have been 
already mentioned at Notes before given; and the various 
ways of using them defined. They chiefly act as caustics 
or as stimulants, and their value in allaying pain and giv- 
ing a momentary check to encroaching sores, is great; 
but the one I have now to mention is Mercury in the form 
or fumes, for this, while it re-excites a healthy action in 
these sores, as the former do, also cures them. Nothing 
that I am acquainted with more certainly and speedily 
controls an eating Venereal ulcer in the throat than the 
fumes of Mercury, and therefore what I now propose to say 
about this is of much importance. The great objection 
to Mercury in fumes used to be the trouble and difficulty 
of using it without its being known. It was necessary, 



for instance, as mentioned in page 209, to procure a red- 
hot heater, which was placed upon a brick ; on this red 
cinnabar was sprinkled, (from half a drachm to a drachm,) 
when fumes will instantly arise ; these were then drawn 
in with the breath by holding an inverted funnel over 
them, and thus was Mercury, in its most penetrating form, 
applied to the surface and edges of the sores. But how 
few could avail themself of this remedy — excellent as 
it was ? Any contrivance therefore calculated to secure 
so great a good without this trouble and exposure must 
be of value. Now, this is perfectly secured in the sim- 
plest possible manner. Just add four drachms of cinna 
bar to one ounce of melted w T ax and make a candle with 
it of a common size. It will be an inch or more in length. 
Then mark three lines around it to make four fumigations 
of the whole ; — of course when it has burnt dowm to the 
first line, one drachm is used, and you put the candle out. 
The moment I first saw this excellent specimen of sim- 
plicity and contrivance suggested, I resolved to lose no 
time in applying it to practice. I can now T add that I 
have used it since with the utmost satisfaction and con- 
fidence. 

The fumigating candle, therefore, is my favorite appli- 
cation to spreading ulcers in the mouth, and T find it stops 
their progress and removes their foul appearance more 
quickly than any other application. A drachm of cinna- 
bar at night, or night and morning, is my usual dose. But 
I have also said the fumes of Mercury cure the disease as 



well as cleanse the sores. This it does by its effect upon 
the constitution. There is no quicker way of inducing 
salivation than by the fumes of Mercury, used more free- 
ly than now directed. It is not often used with this in- 
tention because it is apt to salivate too severely ; but when 
Mercury is given internally, which is generally the case 
when fumes are used, this more limited use of it accele- 
lerates its salutary action. 

The last remark to make upon this subject is, that when 
the throat is brought into a healthy, healing state, the 
Mercury is to be continued for the permanent cure of the 
disease on the common principle. 

The next cause of ulceration of the bones of the nose, 
or roof of the mouth, is one which begins in the form of 

Little ulcerations about the angle of the nose and upper 
lip and cheek. — These, when they seem to spread upward 
in the nose, or without such apparent spreading, when a 
pain or uneasiness referred to the upper and inner part of 
the nose, accompanied by an occasional discharge of mu- 
cus tinged with blood, are present and complained of — 
occurring also when the system has been exposed to the 
disease — afford sufficient reason to consider the bones are 
threatened. This case demands the most judicious and 
decided use of Mercury, in conjunction with such local 
remedies as are known to expedite its influence on the 
system as well as on the part itself, viz., the cinnabar in 



fumes. Of course these should be drawn m by the nose 
instead of the mouth. 

But beside these causes, viz., spreading ulceration of 
the throat and roof of the month, and ulceration begin- 
ning about the angle of the nose and upper lip, — a Ve- 
nereal ulceration may commence in the bones of the nose, 
at once. It first affects the membrane covering them, but 
this being very thin, the bones are soon affected too, and 
are very soon disfigured. There is no occasion to make 
a single comment upon the disgusting appearance which 
disfiguration of the nose gives rise to. 

A Venereal ulceration in the bones of the nose may 
always be suspected, when a person lately having had 
Venereal, feels a little scabby sore in the nose which 
being pricked away is followed by a little bloody mucus. 
This in a day or two will form again, and upon removing 
it will again be followed by the same appearance. In 
this case no time should be lost to bring the constitution 
under the full effect of Mercury. If there should be delay 
and difficulty in doing this, then fumigating should cer- 
tainly be had recourse to, for these will not only expedite 
the effect of Mercury, but in the mean while immediately 
arrest the progress of the ulceration. 

There is now but one additional remark I wish to 
make upon Venereal ulceration of the bones, particularly 
of the nose. 



Whenever any kind of ulceration of the bones takes 
place, its healing or curative process is a slow one ; — the 
diseased part must be separated from the sound part, and 
the prosess by which this is effected is termed exfoliation. 
Now, we will suppose a course of Mercury has been well 
managed in a case of Venereal ulceration of the bones 
and nose, and that the disease is cured, the Mercury dis- 
continued, and the general health, if perchance it had been 
reduced, thoroughly restored. Perhaps, after some weeks, 
or a month or two, there is some uneasiness in the nose 
complained of, with a little discharge of matter, and this 
perhaps offensive to the smell. But what would all this 
be more likely to suggest than that the old disease had 
not been cured, and that a fresh appeal to Mercury should 
be had recourse to. So sure however as this should be 
the course pursued, so surely would it be repented of most 
bitterly. The uneasiness in the nose and the offensive 
discharge attending is nothing more than the necessary 
consequence of the seperation or exfoliation of the disor- 
dered portion of the bone, of the old disorder — the disor- 
der being cured. Now a fresh recourse to Mercury in this 
would only have the effect of renewing the inflamation of 
the bone and producing a fresh exfoliating process. Let 
this remark therefore serve to guard against so great an 
error. Whenever such uneasiness and discharge occurs 
(a judicious and sufficient course of Mercury having been 
completed) it is to be treated, not as Venereal requiring 
the further use of Mercury, but as a necessary process 
in consequence of past disease. The means to have re- 

26 



course to, if indeed any are required at all, are those 
adapted to support the constitution — of which the Sarsa- 
parilla, and the regulation of the digestive organs, together 
with change of air, are the most important. These how- 
ever are not often needed : only let it be remembered that 
Alercury is not to be repeated. 



CHAPTER XIX. 

On Venereal Taint in the Constitution : — 

Its Effects upon Posterity, — the Treatment and Cure, 
On Venereal in Infants, — their Treatment and Cure. 

The proper questions in this Chapter are — in what man- 
ner does a lurking Venereal taint affect posterity 1 — under 
what circumstances would it be a reasonable thing to sus- 
pect the existence of such a cause 1 — and what are the 
means of removing it ? With regard to Stricture, the 
result of a badly-treated Gonorrhoea, as a cause of impo- 
tence, this I have noticed in another place. 

In a former edition I ventured to reason on this subject, 
and.- beside the effects of the disease upon the infant which 
were visible and beyond all doubt, I concluded there was 
another manner in which this latent poison acted, viz., that 
of enfeebling and destroying the power of propagation 
altogether. In this edition, however, I intend to confine 
myself to facts, and those which shall rest on the autho- 
rity of others rather than my own, — venturing only to 
suggest those inferences w T hich seem naturally and una- 
voidably to follow. 

In the first place then, I would observe, that but few- 
persons can have had much practice in midwifery with- 
out having met with many instances of women who have 



m ver gone their time ; or, having completed the full pe- 
riod, have given birth to children either dead or which 
have always, very shortly afterwards died — so that in 
both cases they were childless women. 

In the former instance, the infant thus prematurely 
born has presented proofs that it had died some days be- 
fore delivery. The following are a few instances of these 
facts, selected from many of the same kind, from a work 
by the late Dr. Beatty of Dublin. It is only necessary 
to say, that Dr. Beatty was an eminent, learned and 
practical man, for many years Physician to the lying-in 
Hospital in that city. 

" I delivered a woman in Great Britain street, Dublin, 
of a putrid child, in the eighth month of her pregnancy, 
which, she told me, had been the case with several child- 
ren that she had had before, and that she dispaired *of 
ever having living issue. I enquired very particularly 
into the state of health of both parents, and suspecting 
Venereal taint to be the cause, I proposed to them the 
use of Mercury and seperate beds, until I should be satis- 
fied with the quantity of Mercury used. They readily 
complied with the proposal, and the result was a living 
boy in due time, after the Mercury had been discon- 
tinued ; and their happiness at the event may be more 
readily supposed than described, as they were both at 
the time pretty far advanced in life, and never had ano- 
ther child." 



" I delivered the wife of a cavalry officer of a putrid 
child in the fifth month. The gentleman had been on 
the continent with his regiment without his wife, and had 
contracted a slight Venereal complaint, of which his sur- 
geon considered him well before his wife joined him in 
France. I could not detect any Venereal symptom in 
the parents, but was so satisfied with the cause of the 
child's death, from the peculiar appearance on the body, 
that I recommended him to consult some eminent sur- 
geon ; and Mr. Todd was called in, who saw the regi- 
mental surgeon with me, and advised the use of Mercury, 
which was regularly persevered in by both for several 
weeks. After this course pregnancy was soon the result, 
and I had the gratification of attending her when she 
had a living girl. She has had several living children 
since." 

" In April, 1818, I attended a very fine hearty looking 
women, of her first child, which was born in the eighth 
month, dead and putrid. This, I hoped, was from some 
accidental cause, particularly as she said she had re- 
ceived a fright some time before. However, in June, 
1819, she again lay -in, in the eight month, of a dead 
Venereal child ; and 1 recommended that she should see 
some surgeon, as her husband now confessed that he had 
been disordered before marriage. Mr. Todd saw her, 
and took both under his care until he was satisfied with 
the use of Mercury. She lay-in in September, 1820, of 
a living boy." 

* 20 



Now the inference from all this, and which I take it 
CTery rational being will agree to is the following: That 
Venereal disease, not properly cured, may lie so dormant 
in the constitution as to show itself in no other way than 
in the destruction of posterity. 

Admitting this fact, then, what would be the course 
which every man to whom a succession of such births 
has happened, would be anxious to pursue 1 Would he 
not pursue the following 1 (I say he, for with the mother 
it is, for the most part, out of the question, — it is with the 
father the fault lies). The first consideration would be, 
whether he had ever had Venereal disease at all. If not, 
it would be in vain to reason further, and he would safely 
conclude it arose from some other cause. But if he ever 
had had the Venereal, no matter how long ago, he would 
first consider in what manner he had been treated, (and 
here the observations made in this little book upon the 
proper and necessary use of Mercury, in the cure of this 
disease, will enable him to form a pretty accurate opin- 
ion on this matter). Then the question, to whose care 
he had been under, would naturally occupy his mind ; — 
that is, whether he had fallen into the hands of a boast- 
ing, knavish empiric, or a man of integrity and skill. — 
And lastly, the consideration whether he had had any 
healthy living children, would materially aid him, — for 
where this disease exists it pertains to all — not one es- 
capes its deadly influence. Reflecting on these circum- 
stances then, he would soon determine whether he had 



had just ground to suspect himself to be the cause of these 
serious events, and if this should be the cause, he would 
next inquire if there were any means of cure. This ques- 
tion, however, may be answered with the most gratifying 
confidence — there are ; and they are of a nature too, con- 
sidering the importance of the object, of no extraordinary 
severity or inconvenience. 

The means of cure in a case of lurking Venereal taint 
consists in submitting both husband and wife to a simple 
steady use of Mercury, exactly as for Chancre, but con- 
tinued for a somewhat longer time. During this course, 
the husband and wife must rigidly observe a state of se- 
paration. 

Again, in no wise would it be of any use to put one 
upon a course of Mercury without the other ; or to sub- 
mit each to Mercury at different periods. It is no matter 
whether the husband alone had the disease, originally, 
and the wife apparently never at all. Without any kind 
of reasoning, we must be governed by the fact, and how- 
ever much a mystery it is, experience teaches that it is of 
no use to submit the one to Mercury without the other. 

These things being premised, a course of Mercury, ac- 
cording to the rules laid down for the cure of Chancre, 
but continued for two or three weeks longer, may be en- 
tered on with the greatest confidence of success. The 
course of treatment should be followed by some of the 
tonic restorative decoctions, and, if bowels are not regu- 



lar with restorative aperient medicine, if the constitution 
should in any way be disordered by the Mercury. 

Perhaps it will not be unnecessary here to give one case 
of my own in addition to those selected from Dr. Beatty's, 
— it will show T how easily and successfully it is managed. 

I was engaged to attend a lady in her first confinement. 
It was then about the third month. We went on very 
well till about the seventh, when it was observed she did 
not at all increase in size, nor did she feel the child as 
she had done before. None of us knew exactly what to 
make of it. At the full time, however, I was sent for, 
as labor pains came on, and in a few hours she was de- 
livered of a putrid mass, scarcely in the form of a child. 
But she did well. A few days afterwards I ventured to 
ask the husband if he ever had the Venereal disease, to 
which he said he had, but it was many months before his 
marriage. Then I inquired into the manner in which he 
had taken Mercury, and found it was far from being sa- 
tisfactory. This was quite enough. I persuaded them 
both to undergo a proper course, to which they readily 
consented, and in thirteen months I delivered her again at 
the full time, of a fine healthy boy. 

But another effect of Venereal taint is shown upon in- 
fants born at the full time of living. Here additional 
information is required, both as to the symptoms which 
indicate the disease, and the means required to cure it. 



In some instances infants born under these circumstan- 
ces indicate the disease by a weak and impoverished con- 
dition, together with copper-colored blotches about the 
fundament and genitals, which soon spread to other parts 
of the body. These peculiar copper-colored blotches, es- 
pecially occurring in these parts, are considered almost 
unequivocally as marks of Venereal disease. The coun- 
tenance of such infants have also a peculiar appearance, 
it is a resemblance of extreme old age. 

It still more generally happens, however, that infants 
of such parents that are born alive, have the appearance 
of being healthy and well at first, but in a few days pine 
away and suddenly die; or, that they live to develop the 
fuller marks and unequivocal symptoms of the disease by 
slow degrees. These symptoms Dr. Colles observes, be- 
gin " in a period varying from six to eight days to as 
many weeks." They first appear in copper-colored spots, 
and what is remarkable, these are almost always seen 
about the fundament and organs of generation, spreading 
to the groin, showing a tendency to pass into sores and 
ulcerations. At this time also the voice changes, and it 
cries with a peculiar hoarseness of sound. The disorder 
then proceeds to show itself in little whitish sores about 
the mouth, tongue, throat and nose, from which latter a 
discharge of matter flows, and often dries into crusts, very 
much obstructing its breathing through the nose. If the 
child lives on, other symptoms appear, as sore eys, swell- 
ing of glands, &c, &c. But we must not suppose all 



these symptoms occur together in every case, — sometimes 
but few of them appear, the most common of which are, 
the copper-colored blotches about the fundament and 
adjoining parts — generally followed by some appearances 
in the throat and mouth. Neither, indeed, must it be 
thought that in every instance in which these or similar 
symptoms occur, they are Venereal, for some of them may 
be the consequence of neglect of cleanliness, or a poor 
diet, &c. — and then an attention to these causes, with 
simple remedies, will improve their appearance and ulti- 
mately heal them. Other circumstances also will assist 
the judgement, such as having other children that are 
healthy, and the additional testimony of the conscience on 
the subject. With regard to the 

Treatment of the Venereal disease in Infants, this, in 
seme measure, is peculiar. Of course, in general, when a 
child comes under treatment for this complaint, its parents, 
or its mother at least, does so too. Now, it is a well at- 
tested fact, that when the mother has been put under a 
proper course of Mercury, and she at the same time has 
suckled the child, both the mother and child have got well 
togethei, without giving the child any medicine at all. 
In this case no doubt the infant is cured by the effect of 
Mercury conveyed to it by the milk. It used to be the 
fashion, particularly when the state of the mother's health 
did not allow of sucking, to salivate a goat, and sustain 
the child upon its milk ; but this is not so often now the 
plan pursued. Admitting the fact, however, that the 



milk of the mother under a course of Mercury may cure 
the child, it is generally thought advisable to give the 
infant Mercury too. When therefore it is determined on 
to give the infant Mercury, one of those preparations 
must be chosen that can be most depended on for gentle 
ness of operation. The very greatest caution is required 
to bring an infant successfully through a mercurial course, 
yet it is not impossible. If it should purge, this would 
be checked with a little mixture made of — twenty grains 
of chalk, one drop of laudanum, and a little syrup with 
water to two ounces, — one quarter part of which may be 
given every third or fourth hour till the bowels are re- 
lieved and easy. And, in like manner as in adults, if the 
breath should become offensive, and the gums sore and 
ulcerated, the Mercurial medicine should be omitted for 
a time at least. 

The mildest preparations of Mercury are, first — the 
Creta cum Magnesia, then the Creta cum Hydrargyro, 
then the Blue Pill. The dose of the two former is two 
to five grains, given night and morning ; of the latter one 
to three grains. In giving these directions it is not by 
any means intended to recommend their domestic employ- 
ment. Such cases demand the physician's utmost care 
for any chance of success. 

Without a doubt therefore, it seems that an uncured 
Venereal disease has a fatal effect upon posterity; — i( 
either destroys the infant before its maturity of birth oj 



more gradually unfolds its nature in the living cnild. 
With respect to a third effect, that is, whether it may 
destroy the power of propagation altogether, this, as I 
have said before, having no such positive proofs of, I will 
not venture *o say, farther than as a matter of opinion, 
for I think it does. There are many other curious circum- 
stances which might be mentioned on the subject of this 
Ghapter, but with which I could not conveniently swell 
this little volume. All that are useful and important, as 
well as curious, I have mentioned, of which I think none 
can present a deeper interest than the fact, — that Vene- 
real disorder, if not paoperly cured, may lie so dormant 
and unsuspected in the constitution as to show itself in no 
other way than in its fatal, or miserable effects upon pos- 
terity, if it do not even destroy the procreating faculty 
altogether. 



CHAPTER XX 

On Certain Complaints which Resemble Venereal Dis- 
ease, and sometimes arise from sexual intercourse, but 
which) nevertheless , are not Venereal, nor can be 
treated as such without the greatest disadvantage. 

(Persons affected with these complaints are often cruelly 
imposed upon by advertising people.) 

In Chapter the Eighth I undertook to show that the 
Genital Organs are subject to several disorders resembling 
Gtnorrhcea, which are not really so, but which, however, 
either from ignorance or knavery, are taken for that dis- 
ease and treated as such. The evils arising from this 
dishonorable conduct are there also correctly pointed out. 
But, if the consequences of taking every casual disorder 
of these parts for Gonorrhoea be so lamentable, the mis- 
fortune of taking them for Venereal, and treating them 
accordingly, is ten times more disastrous. It will there- 
fore be my object here, first to show that such innocent 
diseases do occur, and next, how to know thera. 

That the Genital Organs are subject to other diseases 
besides the Venereal, must be evident to every one who will 
for a moment consider the structure of these parts. The 
external organs, for instance, are covered with a con- 
tinuation of the same structure which covers the surface 
of the body, and therefore must be subject to most of the 



21 



diseases which the skin is subject to. If, therefore, a cut 
or tear were to happen to these parts, this would proceed 
in the same manner it would do in any other part of the 
body. Suppose, for example, a simple cut were to hap- 
pen on any other part ; this, in good health, would, if 
kept clean, soon get well. But suppose the health were 
not good, or, instead of being protected from any cause 
of irritation, putrid and offensive matter were applied to 
the wound, — would it then get well ? Certainly not ; 
but would inflame and degenerate into what the surgeons 
call " an ill-conditioned tumor." Now this happens con- 
tinually to the Genital Organs. Under excitement, per- 
haps a little laceration or tear takes place, but this, in 
good health and kept clean, soon gets well ; if, however, 
on the contrary, cleanliness were not observed, or if any 
offensive and acrimonious discharge of the female were 
applied to the laceration, then it would not do well, but 
would inflame and become an obstinate, suspicious, ill- 
conditioned sore. Still, it would not be Venereal, and 
to treat it as Venereal would be to expose the patient to 
the possible destruction of the parts, and certainly to 
much needless anxiety and suffering. Some females are 
very apt to have the natural secretions of the sexual or- 
gans increased in quantity, and when, from any acci- 
dental cause, they are altered in quality also, irritation 
and ulceration after connexion are the frequent conse- 
quences of it. 

Another cause of ulceration arises from want of clean- 



liness in men. Sometimes the natural secretion under 
the foreskin becomes increased in quantity, and, if it is 
suffered to accumulate, it irritates and inflames. The 
discharge from this cause may be considerable, and then 
it is often taken for a Gonorrhoea ; at other times it ul- 
cerates rather than excoriates, and is then taken for Ve- 
nereal disease. 

Again, a Stricture in the urinary passage, as has been 
already noticed, is, now and then, the cause of little ul- 
cers on the penis, which are very apt to be mistaken for 
Venereal sores. 

There is still another kind of ulceration arising from 
Venereal disorder partly cured by Mercury and partly un- 
cured. The organs of generation, as well as other parts 
of the body are subject to them. They have, however, 
very little of the nature of Venereal in them, nor are they 
to be treated as Venereal. Many call these " Pseudo* 
Syphilitic, or Bastard Venereal," of which I shall pre» 
sently have to speak. 

There may also be other disorders of these parts which 
are occasionally mistaken for Venereal, but those I have 
mentioned are the most common, and with a little care 
can easily be distinguished. Indeed there is something 
so peculiar in Venereal disease — something so unlike dis- 
eases of any other kind, that, if its progress be not hasti- 
ly interrupted by ignorance or officiousness, it will be 



easy to destinguish it from every other. The first thing 
is to get acquainted with the genuine peculiar character 
of a true Venereal sore, and, in any particular case in 
which there is a doubt, just wait a little, and if it be Ve- 
nereal, it will put on this peculiarity of character so sa- 
tisfactorily as to leave no doubt about it. The five 
disorders then which I have stated to be most frequently 
mistaken for Venereal, are, — simple laceration, — sores 
arising from acrimonious secretions in the female, — ul- 
cers from a Stricture in the urinary passage, — and sores 
from improperly cured Venereal disease. I will there- 
fore now explain how you can detect them, and how they 
should be treated. 

First, — Simple laceration of the skin during sexual 
excitement. — It will be of great service in this inquiry to 
keep in mind what was said in the former Chapter on the 
true Venereal Chancre. The description there given of 
it is in the words of the great John Hunter, and which I 
will repept. — A genuine Venereal ulcer, he says, is " a 
sore of a somewhat circular form, excavated, with matter 
adhering to its surface, and with a thickened edge and 
base." It was also observed, that a genuine Venereal 
sore did not always put on these peculiarities immediately, 
nor did it always put on every one without exception at 
all, — one or other of them might form imperfectly. Give 
it a little time, however, and a true Venereal sore will 
assume this character, or if in any point it should chance 
to be defective, still there will be enough of what is pe- 



culiar to this kind of sore to enable you to recognize its 
true and specific nature. 

Suppose then you had a simple tear upon the penis 
You would first consider how long it was since you 
had been exposed. But perhaps this might be only a 
few hours, — six or eight; — in this case of course you 
would consider it to be a laceration, and it would have 
been seen immediately if it had been looked for. But 
still, the other party might have been diseased, and Ve- 
nereal matter may have been superadded. Now this 
possibility gives occasion to the advice I am now about 
to press. Do nothing but keep it clean with cold water 
and watch it. Never in such a case consult that class of 
people who call every thing they see upon these parts Ve- 
nereal. This tear, it is true, may be Venereal, but it is 
impossible, at this early period, for any one to say for 
certainty whether it is or not, and a misstatement here, 
whether from ignorance or knavery, would involve the 
direst consequences. 

It is most desirable to impress this fact — the obscurity 
and uncertainty of these early appearances — deeply on 
the mind, and to do it more effectually I will subjoin the 
words of that eminent physician, Dr. Adam Smith, upon 
the subject. In his learned work on morbid poisons, 
page 111, he says — "In whatever part a Chancre occurs, 
its first appearance is often uncertain, depending on the 
constitution, or the sta*e of it at the time the irritation 



21 



commences. It is seldom we see the first vesicle which 
is formed ; more commonly, especially if the disease is on 
the gland, this vesicle is broken and discovers an excori- 
ation, and sometimes a slough. In either of these states, 
it is not easy to ascertain the real character of the disease, 
and all prudent, perhaps I may say all honest men, sus- 
pend their opinions and treatment beyond what may be 
necessary for the immediate symptoms, till the part shows 
a disposition to heal, or discover its true character. 

He then goes on to say — "Nothing can be more cer- 
tain than the true character of a Venereal Chancre, and 
nothing cured with more certainty. The difficulties and 
intricacies attending this form of disease, have arisen from 
indolence, ignorance, or artifice. Those who have not 
industry to attend to the discrimination of ulcers on these 
parts, or who have not had opportunities of distinguishing 
them, may be mistaken ; but unfortunately there is a class 
of men too often applied to in these cases, whose only 
object is the advantage they can make of their patient, 
and who indiscriminately condemn whatever ulcers are 
found in these parts. This is the more disgraceful, not 
only because in the early stage it is often impossible to 
ascertain what such ulcers may be, but because the use 
of Mercury will exasperate some, and induce a degree 
of uncertainty on all whose character has not shown it- 
self before the use of the remedy. " 

In a case of laceration, or an abrasion of the skin of 



the penis, after an exposure to disease, therefore, your 
business is to wait and watch its progress, doing nothing 1 
more than keep it clean by washing it with water. If 
the sore is on the head of the penis, or beneath the fore- 
skin which covers it, it would be as well to apply a little 
piece of lint, simply wetted with water, and draw the 
prepuce over it. Thus watching it, and doing nothing 
that would change its natural course and outward cha- 
racter, you will soon arrive at a knowledge of its real na- 
ture. If it be a simple tear, and nothing of Venereal in 
it, it will soon get well, as any other common sore would 
do. But if Venereal matter should have been superadded 
to the tear, then, sooner or later, generally in a few days, 
it will assume the character given by Hunter of a Vene- 
real Chancre, 01 present at least some of its peculiarities; 
and again, if it should neither heal nor exhibit any of the 
proper characters of Chancre, but present the appearance 
of a common ulcer, then we may conclude it is one of 
those other disorders which are frequently communicated 
by sexual intercourse, but which have nothing of Vene- 
real in them. I have already said that certain vitiated 
secretions in females, or neglect of cleanliness, will pro- 
duce such ulcers, these, however, are not the only causes 
of them. 

If, then, a laceration or an abrasion of the skin upon 
the Genital Organs should be Venereal, it will be known 
by its putting on the peculiar character of a Chancre, as 
before described. The first thing usually observed is a 



hardness both around and beneath it. This you can feel 
by pressing on it with the finger, but by pinching it up 
between the thumb and finger, it is very sensibly distin- 
guished. You cannot well mistake this feel, it is so pe- 
culiar, and as far as I know, it belongs to no other recent 
sore but the true Venereal. 

The next thing is, that simple laceration, if it enlarge, 
does so by spreading superficially ; whereas a Venereal 
sore enlarges by eating deep into the substance of the 
part, and the middle of the ulcer is always the deepest 
part, while the edges of it are a little elevated above the 
surrounding skin, as well as hard. 

Neither does the peculiar color of a Venereal sore al- 
ways show itself immediately, but after a time, and very 
shortly after the symptoms I have mentioned have ap- 
peared, is is covered with a toughish adhering kind of 
matter of a brownish yellowish color, which a simple la- 
ceration never presents. Another thing to remark upon 
these lacerations or abrasions, is, that when they inoculate 
with Venereal matter, that is, when they are Venereal, 
their peculiar Venereal characters do not show them- 
selves so soon, nor in such regular order, nor are they 
always so well defined, as when the disease appears in 
its natural way — when it is absorbed through the skin 
and first appears in the form of a little pimple, without a 
tear or an abrasion of the skin, and on this account it is 
prudent to wait for severeal days, perhaps eight or ten, 
before wp settle whether they really are Venereal or not 



In the event, however, of having waited a reasonable 
and sufficient time, and none of these Venereal characters 
appear, then, if they should not heal, but are inclined to 
inflame or spread, it will be proper to adopt some means 
of healing them. — If pain and inflammation attend, wash- 
ing and bathing them with warm water, or milk and 
water is very good, and after this the common white wash 
(sugar of lead water) is a proper thing ; — some may even 
require a poultice. But if they simply remain stationary, 
without much inflammation, then gently stimulating Lo- 
tions would be proper, such as brandy and water, or one 
of the Lotions or Black Wash, or, if they still remain un- 
healed, touch them with the Lunar Caustic every or every 
other day. Also, take an active purging dose or two of 
pills v 

The second, — Sores arising from, the natural secretion 
beneath the foreskin, which in hot weather or from want 
of cleanliness, accumulates, becoming acrimonious and 
irritating. — The effects of this irritating secretion are 
frequently such as to be taken for Gonorrhoea, as I have 
described Chapter vin ; in this case the head of the penis 
is excoriated and the discharge of matter very copious ; 
at other times it causes ulceration instead of excoriation, 
and then it is that it is apt to be taken for Venereal dis- 
ease. Now the same means which were advised on the 
subject of detecting a suspicious laceration of these parts 



are to be depended on in this case, viz., cleanliness and 
watching. If the sore be Venereal it will show itself by 
assuming the distinguishing marks of that disease, just as 
was described in laceration, but in a shorter time. If not, 
it is probable it will heal under the plan of simple clean- 
liness. If, however, it would not heal, and still present 
none of that hardness so peculiar to Venereal, then a 
stimulent plan, similar to that recommended in simple la- 
ceration, should be resorted to. 

The third, — Sores arising from sexual intercourse with 
females of uncleanly habits, or having certain mild dis- 
orders totally unconnected with Venereal disease. — In this 
place I need do little more than repeat the fact that such 
disorders do occur, referring those who doubt it to ^vhat 
was said on this important subject in the eighth Chapter, 
that which treats on disorders which resemble Gonorrhoea, 
but which have nothing of the nature of that disorder in 
them Here, however, it is proper to observe, that while 
in some these irritating fluids will produce disorder re- 
sembling Gonorrhoea, in others it produces sores which 
are frequently mistaken for Venereal disease. But these 
may easily be detected. — Just compare these little ulcer- 
ations with what was said about the genuine Venereal 
sore or Chancre. Not that it is necessary to keep in mind 
the whole of these peculiarities; for there is one of them 
alone of much more value than all the rest together — it 
is the hardness of its edge and base. Now the sores we 



considering nave not this hardness ; it is, therefore, 
only necessary to ascertain this fact to be pretty certain 
they are not Venereal. 

With respect to the treatment of them, the more sim- 
ple this is the better, for although they will not always 
heal with simple remedies, such simple remedies should 
always first be tried. I would, therefore, advise that at 
first nothing but lint soaked in cold water be applied to 
them. This is best suited to those which are situated 
between the prepuce and the head of the penis, for here 
the prepuce can be drawn over and made to cover it; but 
if they are situated on the outer parts, white cerate may 
be spread upon the lint and this lapped round the penis 
and confined there. You are not however to expect that 
these will always heal like common sores, for it must be 
remembered they originate in a kind of animal poison, 
though not Venereal. If, therefore, they do not heal 
under this simple means, we must advance upon the 
stimulating plan, just as in the two former species. I 
should therefore begin with the Black Wash, and if that 
did not succeed, I would try another Lotion, soaking 
a piece of lint with it instead of the cold water. In some 
instances I have dipped my finger in the powder of white 
vitriol, and held it to the sores for a minute or two, or 
more, with very good effect. In other slow and tedious 
cases, I have touched them with the Lunar Caustic every 
day or two. 



These sores in general do not require the internal use 
of Mercury; indeed, some of them are generally exaspe- 
rated by it, while others are as greatly benefitted ; in such 
however, the Mercury is given in a milder form than in 
Venereal. In every case it is of especial service to re- 
gard the state of the digestive organs, that is, the sto- 
mach and the bowels. If these are in a disordered state, 
which is shown by a whitish looking tongue, furred in 
the morning at its root with a brownish coat, the bowels 
*t the same time irregular, and the stools of an unnatural 
smell or color, depend upon it there will be difficulty in 
healing them while this continues. Nothing however is 
easier than to correct this state. The best way to do it is 
to take Rhubarb and Soda for a week or ten days, with 
a blue pill every other night, or, the rhubarb alone would 
do. Just keep a piece of Turkey rhubarb in your 
waistcoat pocket, and every morning nibble off a portion 
a little larger than a pea, or just enough to keep the 
bowels rather more relaxed than natural. Simple as 
these remedies may seem, it is astonishing to see the 
good which results, and not only in this, but in a vast 
variety of maladies accompanied with these symptoms 
of disordered stomach. 

The fourth, — Sores on the Penis in consequence of 
Stricture in the urinary passage. — When speaking of 
Stricture in a former Chapter, it was stated that among 
a number of consequences arising from that disorder, ul- 



cers on some part or other of the Genital Organs was one. 
The fact itself is strange, but admits of explanation. It 
depends on a law of sympathy — a power of the nervous 
system which produces disease in one part from a disor- 
der seated in another; thus disorder of the stomach pro- 
duces pain and disease in the head; and in that painful 
disease the stone, the pain is felt not in the bladder, the 
seat of the disease, but in the tip of the penis. In like 
manner, a Stricture occasionally produces irritation and 
disease of the penis, or in the testicles, or elsewhere. 

The late Mr. Abernethy of London took much pains 
to explain the nature and treatment of these ulcers. He 
was led to this from meeting occasionally with very ob- 
stinate sores on the penis which did not correspond with 
what he called Pseudo-Syphilitic, (a kind of sore I shall 
presently have to mention,) and which at length he found 
to originate in Stricture of the urinary passage. Further, 
in the correctness of this opinion be became afterwards 
fully satisfied, by rinding that ulcers of this kind, which 
had resisted every means that could be devised, or which 
if healed, would afterwards re-appear again and again, 
were speedily and permanently cured on the removal of 
the Stricture. My own experience also warrants me in 
saying that Stricture does occasionally produce this ob- 
stinate and often-recurring kind of ulcer on the penis ; 
and, indeed, accordingly, whenever I meet with sores of 
a peculiarly unyielding nature, being also deficient in 
other features proper to Venereal, I am always inclined 
to suspect they originate in Stricture; and further, if 



22 



upon inquiry, it appears my patient never had the true 
Venereal, but only a Gonorrhoea, my suspicion is con- 
firmed, nor do I rest until, by passing a bougie, I ascer- 
tain the fact whether it be so or not. 

With respect to the treatment of this kind of sore, it 
is scarcely necessary to say that it consists in a removal 
of the Stricture. When this is done, and even while it is 
doing, these ulcers generally heal under any simple dres- 
sing — if not, those dressings already recommenced under 
the stimulant plan never fail to heal them once for all. 

The fifth ; — A species of sore upon the penis, the result 
of an ineffectual course of Mercury for the cure of Vene- 
real disease, the same which .Mr. Abernethy has denomi- 
nated "Pseudo-Syphilitic, or Bastard Venereal.'' — This 
is a difficult part of the subject to write about, and it does 
not, I think, properly concern the general reader. In- 
deed, I should not have mentioned it at all, but for a wish 
to make this little volume as complete as possible, and 
also to interest the medical as wel I as the general reader. 
Those who are afflicted with the obscurer forms of Vene- 
real disease, should never undertake their management 
themself, but, if posihle, should consult the most expe- 
rienced surgeon to be found. 

Mr. Colles, that practical and excellent author on Ve- 
nereal disease, so often referred to in this little work, 
justly observes, there is no class of complaints which does 



not occasionally fail to present its distinguishing charac- 
ters, or present them so faintly as scarcely to be recog- 
nized. Now, it is just this that creates the difficulty ; for, 
when a suspicious or irregular sore presents itself, it is 
hard to tell whether it is one of these Venereal sores 
which have failed in exhibiting its distinguishing charac- 
ters, or of a Pseudo-Syphilitic kind. 

This bastard sort of Venereal we are now considering is 
supposed to be a compound of Venereal disease, partially 
cured by Mercury, blended with some other disorder of the 
constitution, such as Scrofula. The great scource of this 
kind of disease is the use of Mercury by unskillful peo- 
ple. Being known to almost every one that Mercury 
will cure the Venereal disease, persons of every grade of 
ignorance presume on this, and give it indiscriminately 
and ineffectually. There is scarcely a shoe-black who 
will not prescribe it to his acquaintance if he is fool enough 
to take it, and hence, almost exclusively, that perplexing 
host of Pseudo-Syphilitic maladies The fact is, although 
Mercury is the safest and most certain remedy for the cure 
of Venereal disease, there is no article in medicine which 
requires a more skillful and experienced mind in prescri- 
bing it; or, closer attention to the rules which have been 
given in a preceding Chapter for its proper management. 
And it may be further added, neither is there any one dis- 
order which calls for profounder knowledge in every sin- 
gle department of medical education, than that for which 
Mercury is so peculiarly the remedy — the Venereal dis- 



ease. Who then can wonder that these perplexing and 
destructive cases should so frequently occur. 

Mercury, therefore, given ineffectually, fails in curing 
the Venereal disease ; in this case, after a time, it re-ap 
pears, and Mercury is again resorted to. Still, however, 
given as before, the disease again appears, not perhaps 
exactly in the same form ; for, being interrupted thus re- 
peatedly, it looses much of its external Venereal charac- 
ter, so that it is not so easy to tell whether it is Venereal 
or not. At length, however, these repeated ineffectual 
modes of giving Mercury break down the constitution, 
and thus excite in it whatever malady it might be dis- 
posed to. This, very frequently, is some form or other of 
Scrofula, and this disorder, Scrofula, blending with Vene- 
nereal, forms this Pseudo-Syphilis — appearing sometimes 
in the bones, or in blotches on the skin, and sometimes in 
a little ulcer on the penis. 

Now, in order to detect the nature of these sores, it is 
necessary to ponder well both over the history and the 
treatment in each case. It is of course essential to as- 
certain that there has been, at some time or other, real 
Venereal disease; and also, that Mercury has been given 
for its cure. It is also expedient to be certain they do 
not arise from Stricture, for a person may have had Go- 
norrhoea and Venereal too, and the Venereal being cured, 
these sores may arise from Stricture, the result of Go- 
norrhoea. 



With respect to the treatment of them, I can do little 
more than speak of this in general terms. It consists in 
giving very small doses of Mercury, and continuing it for 
a considerable length of time. This also combined with 
such remedies as support or recruit the general health 
and strength ; such as Bark, Quinine, or Sarsaparilla. — 
Change of air, especially to the sea-side, has been found 
exceedingly useful. Also, all that has been said on the 
utility of maintaining a regular and healthy state of the 
stomach and bowels in diseases generally, applies espe- 
cially to this case. Indeed, I have known many obstinate 
disorders of the Genital Organs greatly benefitted or en- 
tirely cured simply by attending to this one subject, and 
I should consider that that case was under no unpromising 
course of cure which was under the treatment of the 
Rhubarb and Soda, or some mild kind of tonic ape- 
rient and, perhaps, together with the Blue Pill, as di- 
rected beforehand, and continued for some months. In 
such a case the mixture or pill might be omitted after a 
week or two, or only resorted to as the state of the 
bowels might require, while the Blue Pill should be con- 
tinued regularly every other night. 



